胃小細胞癌の1例 [in Japanese] A CASE OF GASTRIC SMALL CELL CARCINOMA [in Japanese]
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胃の小細胞癌は稀な疾患であり,予後も極めて不良である.今回われわれは噴門部の2型小細胞癌を経験した.症例は63歳,男性.食後つかえ感にて近医受診.上部消化管内視鏡検査を施行され2型噴門部小細胞癌の診断で当科紹介となった. CTにて胃小彎に40×45mm大のリンパ節の腫大を認め,血管造影では左胃動脈～脾動脈を圧排していた. T3, N1, M0, Stage IIIAの噴門部胃癌の診断で胃全摘脾臓合併切除術施行した.術中所見は,主病巣はSE, 洗浄細胞診はCY0, 小彎リンパ節は左胃動脈,脾動脈から剥離し切除しえた(最終病理診断: small cell carcinoma, T3, int, INFγ, 1y3,v2, pN1, Stage IIIA, 根治度B).術後経過は特に問題なく良好であった.術後補助化学療法としてPE療法(Cisplatin/Etoposide併用療法)施行した.術後10カ月で多発肝転移認めたため, CDDP/CPT-11併用療法施行.徐々に転移巣増大し,術後14カ月で永眠された.
Small cell carcinoma of the stomach is a very rare neoplasm, and this tumor has an aggressive feature with a poor prognosis. In this report we present a case of a patient with a small cell carcinoma of the stomach. A 63-year-old male was referred to our hospital with complaint of sensation of food sticking at swallowing. Upper gastrointestinal X-ray examinations and endoscopic examinations revealed a giant ulcerative tumor at the cardia of the stomach. Biopsy specimens were diagnosed as small cell carcinoma. Abdominal CT scan revealed a metastatic lymph node, 40×45mm in size, along the lesser curvature of the stomach. The gastric cancer showed T3, N1, M0, and was in Stage IIIA. Total gastrectomy was conducted with lymph node dissection (T3, int, INFγ, ly3, v2, pN1). Adjuvant chemotherapy using Cisplatin and Etoposide was performed. However, multiple liver metastases were detected ten months after the operation. Although chemotherapy using CPT-11 and Cisplatin was immediately performed, the metastatic lesions grew gradually and he passed away 14 months after surgery.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 66(10), 2436-2440, 2005-10-25
Japan Surgical Association