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一例罕见的以耳聋为表现的胃癌脑膜癌病及内耳道转移病例。

A rare case of meningeal carcinomatosis and internal auditory canal metastasis presenting with the deafness for gastric cancer.

作者信息

Tanaka Takayuki, Kanetaka Kengo, Ikeda Takahiro, Yamaguchi Shun, Kawakami Syunsuke, Kitajima Tomoo, Iwata Toru, Eguchi Susumu

机构信息

Department of Surgery, Nagasaki Rosai Hospital, 2-12-5 Setogoshi, Zip code 857-0134, Sasebo, Nagasaki, Japan.

Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Zip code, 852-8501, Nagasaki, Nagasaki, Japan.

出版信息

Surg Case Rep. 2020 Nov 23;6(1):295. doi: 10.1186/s40792-020-01018-1.

DOI:10.1186/s40792-020-01018-1
PMID:33226536
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7683756/
Abstract

BACKGROUND

Meningeal carcinomatosis is a very rare metastatic site of gastric cancer and meningeal carcinomatosis without other metastatic sites is much extremely rare. Herein, we report our experience with a very rare case of meningeal carcinomatosis which was difficult to diagnose the recurrence by general systemic examination and was found due to the deafness despite the sustained high tumor markers.

CASE PRESENTATION

A 68-year-old man consulted a hospital with vomiting and hematemesis. Laboratory tests revealed severe anemia. He was referred to our hospital and underwent an emergency gastroscopy, which revealed Borrman type 3 tumor and oozing of blood. Biopsy specimen showed gastric cancer. After several examinations, total gastrectomy was performed and tegafur-gimeracil-oteracil potassium (S-1) was initiated as adjuvant chemotherapy one month after surgery. Tumor marker levels (CEA and CA19-9) remained high for three months after surgery. S-1 was continued while shortening the imaging study follow-up period. Nine months after surgery, he noticed difficulty in hearing with facial paralysis, dizziness, tinnitus, and appetite loss. He was diagnosed with meningeal carcinomatosis and bilateral internal auditory canal metastasis. He died approximately two months later.

CONCLUSION

Meningeal carcinomatosis should be considered if bilateral deafness and vestibulopathy develop after gastrectomy, even if no recurrence is apparent in the abdominal cavity.

摘要

背景

脑膜癌病是胃癌非常罕见的转移部位，而无其他转移部位的脑膜癌病极为罕见。在此，我们报告一例非常罕见的脑膜癌病病例，该病例通过常规全身检查难以诊断复发，尽管肿瘤标志物持续升高，但因耳聋而被发现。

病例介绍

一名68岁男性因呕吐和呕血到一家医院就诊。实验室检查显示严重贫血。他被转诊至我院，接受了急诊胃镜检查，结果显示为Borrmann 3型肿瘤并渗血。活检标本显示为胃癌。经过多项检查后，进行了全胃切除术，并在术后1个月开始使用替吉奥（S-1）作为辅助化疗。术后3个月肿瘤标志物水平（癌胚抗原和糖类抗原19-9）持续升高。继续使用S-1，同时缩短影像学检查随访期。术后9个月，他出现听力困难、面瘫、头晕、耳鸣和食欲减退。他被诊断为脑膜癌病和双侧内耳道转移。大约两个月后死亡。

结论

即使腹腔内未发现明显复发，胃切除术后出现双侧耳聋和前庭病变时，也应考虑脑膜癌病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/d80fb2c47275/40792_2020_1018_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/a78432e98edd/40792_2020_1018_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/f5dd7bb7761a/40792_2020_1018_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/4e273f287cb2/40792_2020_1018_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/d80fb2c47275/40792_2020_1018_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/a78432e98edd/40792_2020_1018_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/f5dd7bb7761a/40792_2020_1018_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/4e273f287cb2/40792_2020_1018_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99d6/7683756/d80fb2c47275/40792_2020_1018_Fig4_HTML.jpg

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