Okazaki Yuki, Shibutani Masatsune, Nagahara Hisashi, Fukuoka Tatsunari, Iseki Yasuhito, Wang En, Maeda Kiyoshi, Hirakawa Kosei, Ohira Masaichi
Dept. of Gastroenterological Surgery, Osaka City University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2343-2345.
The patient was a 70-year-old woman who had received distal gastrectomy for the gastric cancer which histology was poorly differentiated adenocarcinoma, pT4a(SE), ly2, v0, pNX, H0, P1, cy0 and pStage Ⅳ. She was treated with SOX after the operation. However, 4 years after gastrectomy, contrast enhanced abdominal CT showed a mass in the cecum and colonoscopy revealed submucosal-like tumor in the cecum, but the pathological diagnosis was unclear. We diagnosed the malignant tumor in the cecum and performed laparoscopic ileocolic resection. Histology of the tumor showed a poorly differentiated adenocarcinoma and immunohistochemical staining showed CK7+, CK20± and CDX2±, therefore, the colon tumor was diagnosed as a metastasis from the gastric cancer. After the ileocolic resection, she was treated with SOX. It was suggested that we need to consider colon metastasis from gastric cancer in mind, when we find submucosal-like tumor in colon after gastric cancer resection.
该患者为一名70岁女性，因组织学类型为低分化腺癌的胃癌接受了远端胃切除术，pT4a(SE)，ly2，v0，pNX，H0，P1，cy0，p分期为Ⅳ期。术后接受了SOX方案治疗。然而，胃切除术后4年，腹部增强CT显示盲肠有一肿块，结肠镜检查发现盲肠有黏膜下样肿瘤，但病理诊断不明确。我们诊断盲肠为恶性肿瘤并进行了腹腔镜回结肠切除术。肿瘤组织学显示为低分化腺癌，免疫组化染色显示CK7+、CK20±和CDX2±，因此，结肠肿瘤被诊断为胃癌转移。回结肠切除术后，她继续接受SOX方案治疗。提示胃癌切除术后在结肠发现黏膜下样肿瘤时，需考虑胃癌的结肠转移。
