Kawabata Ryohei, Ushimaru Yuki, Hara Hisashi, Takeoka Tomohira, Yasuhara Yumiko, Yoshihara Terukazu, Kitagawa Akihiro, Takeda Takashi, Tomihara Hideo, Naito Atsushi, Murakami Masahiro, Noura Shingo, Miyamoto Atsushi
Department of Gastrointestinal Surgery, Sakai City Medical Center, Sakai, Osaka, Japan.
Department of Gastrointestinal Surgery, Osaka International Cancer Center, Osaka, Osaka, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0318. Epub 2025 Jul 1.
Idiopathic multicentric Castleman disease (iMCD) is a rare lymphoproliferative disorder characterized by systemic inflammation and chronic immunosuppression. When solid malignancies such as gastric cancer arise in patients with iMCD, perioperative management becomes particularly challenging due to nutritional decline, reactive lymphadenopathy, and elevated surgical risk.
A 75-year-old man with a 26-year history of suspected iMCD treated with low-dose corticosteroids presented with epigastric discomfort. Endoscopy revealed a Borrmann type 2 lesion, and biopsy confirmed poorly differentiated adenocarcinoma. CT showed mild lymphadenopathy along the lesser curvature and left gastric artery, as well as systemic involvement. Inguinal node biopsy confirmed polyclonal plasma cell proliferation consistent with iMCD. The patient also met the Asian Working Group for Sarcopenia (AWGS) criteria for severe sarcopenia. A multidisciplinary team initiated preoperative respiratory rehabilitation, nutritional support, and resistance exercise therapy. Curative distal gastrectomy with D2 lymphadenectomy was performed without complications. Histopathology revealed pT2N0M0 (pStage IB) disease. Tocilizumab was started 3 months postoperatively, and the patient remains recurrence-free at 24 months.
This case highlights that, even in patients with long-standing iMCD and sarcopenia, carefully staged multimodal perioperative care-including accurate nodal evaluation and individualized systemic therapy-can enable successful curative surgery for advanced gastric cancer.
特发性多中心Castleman病（iMCD）是一种罕见的淋巴增生性疾病，其特征为全身炎症和慢性免疫抑制。当iMCD患者发生胃癌等实体恶性肿瘤时，由于营养状况下降、反应性淋巴结病和手术风险升高，围手术期管理变得尤其具有挑战性。
一名75岁男性，有26年疑似iMCD病史，一直接受小剂量皮质类固醇治疗，出现上腹部不适。内镜检查发现为Borrmann 2型病变，活检确诊为低分化腺癌。CT显示沿胃小弯和胃左动脉有轻度淋巴结病以及全身受累。腹股沟淋巴结活检证实为与iMCD一致的多克隆浆细胞增殖。该患者还符合亚洲肌少症工作组（AWGS）严重肌少症的标准。一个多学科团队开展了术前呼吸康复、营养支持和抗阻运动治疗。进行了根治性远端胃切除术及D2淋巴结清扫术，未发生并发症。组织病理学显示为pT2N0M0（p分期IB期）疾病。术后3个月开始使用托珠单抗治疗，患者在24个月时仍无复发。
本病例表明，即使是患有长期iMCD和肌少症的患者，精心安排的多模式围手术期护理——包括准确的淋巴结评估和个体化的全身治疗——也能够成功地对进展期胃癌进行根治性手术。
