内容紹介
A Case Report of Two-Term Surgery for Focal Progression of a Huge Liver Metastasis and Peritoneal Dissemination from Gastrointestinal Stromal Tumor during Imatinib Mesylate Treatment
Summary
We report a patient who underwent 2-term surgery to treat focal progression of a huge liver metastasis and peritoneal dissemination from a gastric gastrointestinal stromal tumor(GIST)during imatinib mesylate treatment. A 59-year-old man underwent an emergency surgery for perforative peritonitis caused by gastric GIST in June 2006 and a partial resection of the stomach in September 2006. Four years later, abdominal computed tomography(CT)detected a huge liver tumor that occupied the entire right lobe. We initiated imatinib mesylate treatment(400 mg/day), and the patient maintained stable disease for several months. However, focal progression of the huge liver tumor and a peritoneal tumor at the splenic hilum were revealed by CT; therefore, an extended right hepatic resection was performed in August 2011 and a distal pancreatectomy, splenectomy, and partial resection of the stomach were performed in February 2012. The patient died of the primary disease at 16 months after the hepatic resection for focal progression.
要旨
胃GISTの術後巨大肝転移,腹膜再発の部分耐性に対して,二期的に部分耐性を切除した1例を経験したので文献的考察を加えて報告する。症例は初診時59歳,男性。2006年6月に胃GISTの穿孔で緊急手術を施行し,9月に胃部分切除術を施行した。2010年9月の腹部CTで肝右葉のほとんどを占める巨大肝転移を認めた。メシル酸イマチニブ(イマチニブ)を投与しSDを得られたが,肝転移,脾門部腫瘤の2病変の部分耐性となった。2011年8月に拡大肝右葉切除術,2012年2月に膵体尾部・脾合併切除,胃部分切除術を施行し,部分耐性の腫瘍を切除した。イマチニブの部分耐性に対する初回手術後16か月で原病死した。
目次
Summary
We report a patient who underwent 2-term surgery to treat focal progression of a huge liver metastasis and peritoneal dissemination from a gastric gastrointestinal stromal tumor(GIST)during imatinib mesylate treatment. A 59-year-old man underwent an emergency surgery for perforative peritonitis caused by gastric GIST in June 2006 and a partial resection of the stomach in September 2006. Four years later, abdominal computed tomography(CT)detected a huge liver tumor that occupied the entire right lobe. We initiated imatinib mesylate treatment(400 mg/day), and the patient maintained stable disease for several months. However, focal progression of the huge liver tumor and a peritoneal tumor at the splenic hilum were revealed by CT; therefore, an extended right hepatic resection was performed in August 2011 and a distal pancreatectomy, splenectomy, and partial resection of the stomach were performed in February 2012. The patient died of the primary disease at 16 months after the hepatic resection for focal progression.
要旨
胃GISTの術後巨大肝転移,腹膜再発の部分耐性に対して,二期的に部分耐性を切除した1例を経験したので文献的考察を加えて報告する。症例は初診時59歳,男性。2006年6月に胃GISTの穿孔で緊急手術を施行し,9月に胃部分切除術を施行した。2010年9月の腹部CTで肝右葉のほとんどを占める巨大肝転移を認めた。メシル酸イマチニブ(イマチニブ)を投与しSDを得られたが,肝転移,脾門部腫瘤の2病変の部分耐性となった。2011年8月に拡大肝右葉切除術,2012年2月に膵体尾部・脾合併切除,胃部分切除術を施行し,部分耐性の腫瘍を切除した。イマチニブの部分耐性に対する初回手術後16か月で原病死した。