胃癌異時性脾転移の1切除例 [in Japanese] A RESECTED CASE OF HETEROCHRONOUS SPLENIC METASTASIS OF GASTRIC CANCER [in Japanese]
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64歳,男性.体下部3型胃癌に対し,幽門側胃切除術, 2群リンパ節郭清を施行した.胃癌は中分化腺癌で漿膜に接しており, 2群リンパ節転移を伴っていた.腫瘍マーカーが徐々に上昇し, 22カ月後にはCEA69.3ng/mlとなった.CT所見では,脾臓の横隔膜側に3cm大と2cm大の腫瘍が接していた.他に明らかな転移を認めなかったため,脾摘出術を行った. 2個の腫瘍はともに白色で多結節性であった.病理組織学的には脾腫瘍は腺癌で胃癌転移と診断した.脾門部にリンパ節転移を認めず,血行性転移と考えている.術後12カ月の現在,無再発生存中である.<br> 医学中央雑誌で検索すると,胃癌異時性脾転移は自験例を含めて13例と稀であった.術後平均生存期間は14.5カ月であった.摘出例11例では6例が1年以上生存しており,摘出する意義はあると考える.
A 64-year-old man underwent a distal gastrectomy with dissection of second group of lymph nodes for type 3 gastric cancer at the lower body of stomach. The gastric cancer was moderately differentiated adenocarcinoma invaded to serosa, and involved the second group of lymph nodes. Tumor makers gradually increased and the CEA level became 69.3ng/ml 22 months after the operation. Abdominal CT scan showed a 3-cm and 2-cm sized tumors which were adjacent each other in the diaphragm side of the spleen. No other prominent metastatic lesions were demonstrated, so that a splenectomy was performed. The two tumors were white in color and multinodular. Histopathologically the splenic tumors were adenocarcinoma, and were diagnosed as metastasis of gastric cancer. No lymph node metastasis was noted in the splenic hilum, and thus we considered that hematogenic metastasis had occurred in this case. He has been recurrence free as of 12 months after the operation.<br> In a review of the Japanese Journal of Igaku Chuo, so far only 13 cases of heterochronous splenic metastasis of gastric cancer, including our case, have been reported. A mean survival time after surgery was 14.5 months. As for 11 cases in which splenectomies were performed, six patients survive or survived more than one year. Thus we consider that the splenectomy for such patients has a meaning.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(10), 2457-2460, 2006-10-25
Japan Surgical Association