Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Department of Medical Oncology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Clin J Gastroenterol. 2022 Feb;15(1):90-94. doi: 10.1007/s12328-021-01564-7. Epub 2022 Feb 3.
Brain metastasis post-curative gastrectomy for early-stage gastric cancer is extremely rare. We present herein, a case of solitary brain metastasis that developed 4 years post-curative surgery for early-stage gastric cancer. A 60-year-old man had early-stage gastric cancer 4 years prior to presentation and underwent laparoscopy-assisted distal gastrectomy with lymph node dissection. The pathological TNM classification was T1b (submucosal) N0M0. He underwent scheduled examinations and had no recurrence. 4 years postoperatively, he presented to the emergency department with sudden onset of nausea, vomiting, and inability to speak clearly. Brain computed tomography revealed a 17-mm nodule in the right cerebral hemisphere and midline shift. The tumor could not be radically resected for anatomical reasons, and incisional biopsy was performed for histological examination. Histological examination confirmed the diagnosis of a poorly differentiated adenocarcinoma from the previous gastric cancer. Gamma knife radiosurgery and chemotherapy were scheduled. 28 months after brain metastasis, multiple liver and lung metastases appeared. The patient died 30 months after developing brain metastasis. Brain metastasis may occur during long-term follow-up even after curative resection of early-stage gastric cancer. In patients with a history of gastric cancer and neurological symptoms, brain metastasis should be considered.
根治性胃切除术后早期胃癌的脑转移极为罕见。本文报告了 1 例早期胃癌根治术后 4 年发生的单发脑转移病例。患者为 60 岁男性，就诊前 4 年前诊断为早期胃癌，并接受了腹腔镜辅助远端胃癌根治术和淋巴结清扫术。病理 TNM 分期为 T1b（黏膜下）N0M0。他接受了定期检查，没有复发。术后 4 年，他因突发恶心、呕吐和言语不清而到急诊科就诊。脑 CT 显示右侧大脑半球有 17mm 结节和中线移位。由于解剖原因无法进行根治性切除，因此进行了切取活检以进行组织学检查。组织学检查证实为来自先前胃癌的低分化腺癌。计划行伽玛刀放射外科手术和化疗。脑转移后 28 个月，出现多发肝和肺转移。患者在发生脑转移后 30 个月死亡。即使在早期胃癌根治性切除术后，长期随访中也可能发生脑转移。对于有胃癌病史和神经系统症状的患者，应考虑脑转移的可能。
