Nakata Y, Watanabe Y, Nakata T, Kimura K, Sato M, Kawachi K
Department of Surgery, Kitaishikai Hospital, Ehime, Japan.
Surg Today. 1998;28(7):753-7. doi: 10.1007/BF02484624.
We report herein the first known case of early gastric cancer with synchronous liver metastasis forming a portal tumorous embolism. A 62-year-old man was found to have multiple liver tumors and a portal tumorous embolism by ultrasonography. A gastroscopy subsequently showed Borrmann type III-like gastric cancer in the antrum. His carbohydrate antigen (CA) 19-9 level was elevated to 8280 U/ml, but the alpha-fetoprotein level was within normal limits. A laparotomy revealed multiple liver metastasis and subpyrolic lymph-node enlargement; a distal partial gastrectomy with group 1 lymph-node dissection for the gastric cancer in the antrum, and cannulation of the proper hepatic artery for postoperative chemotherapy were performed. Histopathologically, the cancer was found to be a medullary type well-differentiated adenocarcinoma. Subpyrolic lymph node metastasis was noted, but cancer invasion was localized to only the mucosal and submucosal layers of the stomach. Thus, the patient was diagnosed as having early gastric cancer. Adjuvant chemotherapy given through the cannula suppressed further elevation of CA19-9 levels, and a total of 26 Gy irradiation to a liver tumor, which had caused ascites by pressing on the inferior vena cava, diminished the ascites. The patient was able to remain at home with treatment for 7 months after radiation therapy, but finally died of cancer with jaundice 13 months after his operation. Therefore, although adjuvant chemotherapy and radiation therapy contributed to improving his quality of life, it could not prolong survival.
我们在此报告首例已知的早期胃癌伴同步肝转移形成门静脉瘤栓的病例。一名62岁男性经超声检查发现有多发肝肿瘤和门静脉瘤栓。随后胃镜检查显示胃窦部为Borrmann III型样胃癌。其糖类抗原（CA）19-9水平升高至8280 U/ml，但甲胎蛋白水平在正常范围内。剖腹手术发现多发肝转移及幽门下淋巴结肿大；对胃窦部胃癌行远端部分胃切除术并清扫第1组淋巴结，同时对肝固有动脉插管用于术后化疗。组织病理学检查发现该癌症为髓样型高分化腺癌。可见幽门下淋巴结转移，但癌浸润仅局限于胃黏膜和黏膜下层。因此，该患者被诊断为早期胃癌。通过插管进行的辅助化疗抑制了CA19-9水平的进一步升高，对压迫下腔静脉导致腹水的肝肿瘤总共进行26 Gy的照射后腹水减少。放疗后患者能够在家接受治疗7个月，但最终在术后13个月因癌症伴黄疸死亡。因此，尽管辅助化疗和放疗有助于改善其生活质量，但未能延长生存期。
