Eto Ryotaro, Ambiru Satoshi, Yoshidome Hiroyuki, Itabashi Terumi, Furuya Seiji, Shimura Takanori, Isshiki Yusuke, Sugita Yasumasa
Dept. of Surgery, Oami Municipal Hospital.
Gan To Kagaku Ryoho. 2021 Mar;48(3):367-369.
A 72-year-old woman was admitted to our hospital because of symptoms of bleeding diathesis such as hematuria and purpura. A blood test revealed disseminated intravascular coagulation(DIC). Upper gastrointestinal endoscopy showed advanced gastric cancer. Bone marrow aspiration cytology demonstrated diffuse hyperplasia of large atypical cells, and metastasis of the epithelial tumor was suspected on immunohistochemical examination. She was diagnosed with disseminated carcinomatosis of the bone marrow associated with gastric cancer accompanied by DIC. She was treated with weekly infusion of methotrexate 100 mg/m2 plus 5-fluorouracil 600 mg/m2 for 4 courses; and she completely recovered from DIC. She received oral tegafur/gimeracil/oteracil as an outpatient. However, DIC recurred 126 days after the initial chemotherapy, and 5-fluorouracil plus cisplatin was administered subsequently. After 1 course, she died 166 days after the initial chemotherapy. Although the prognosis of patients with disseminated carcinomatosis of the bone marrow associated with gastric cancer accompanied by DIC is extremely poor, this case shows that secession of DIC and prognostic improvement by chemotherapy could occur. Chemotherapy could be considered a potentially effective treatment in this case.
一名72岁女性因血尿和紫癜等出血倾向症状入住我院。血液检查显示弥散性血管内凝血（DIC）。上消化道内镜检查显示为进展期胃癌。骨髓穿刺细胞学检查显示大的非典型细胞弥漫性增生，免疫组化检查怀疑上皮肿瘤转移。她被诊断为与胃癌相关的骨髓播散性癌病伴DIC。她接受了每周一次静脉输注甲氨蝶呤100 mg/m²加5-氟尿嘧啶600 mg/m²，共4个疗程的治疗；她的DIC完全康复。她作为门诊患者接受了替加氟/吉美嘧啶/奥替拉西口服治疗。然而，初始化疗126天后DIC复发，随后给予5-氟尿嘧啶加顺铂治疗。1个疗程后，她在初始化疗166天后死亡。尽管与胃癌相关的骨髓播散性癌病伴DIC患者的预后极差，但该病例表明化疗可能使DIC缓解并改善预后。在这种情况下，化疗可被视为一种潜在有效的治疗方法。
