内容紹介
A Case of StageⅣ Gastric Cancer with Development of Trousseau's Syndrome during Neoadjuvant Chemotherapy
Summary
In October 2012, a man in his 60s was hospitalized for the examination of ascites, and was diagnosed with gastric cancer and carcinomatous peritonitis. S-1+cisplatin(CDDP)therapy was administered as neoadjuvant chemotherapy; however, during therapy, he developed cerebral infarction. We suspected that the cerebral infarction was caused by a coagulation disorder owing to Trousseau's syndrome. After completing 5 courses of chemotherapy, total gastrectomy was performed. Thereafter, the treatment was changed to S-1+docetaxel(DTX), followed by nab-paclitaxel(PTX). Although cerebral infarction did not relapse after the administration of an anticoagulant agent, the patient died of gastric cancer 1 year and 5 months after the operation. Trousseau's syndrome is a coagulation disorder in cancer patients. Cerebral infarctions caused by Trousseau's syndrome have a high tendency to relapse, and the prognosis is poor. This syndrome should be kept in mind when treating cancer patients.
要旨
症例は60歳台,男性。2012年10月,腹水貯留の精査を目的に入院し,胃癌およびそれによる癌性腹膜炎と診断された。術前化学療法としてS-1+cisplatin(CDDP)療法を開始したが,化学療法中に脳梗塞を発症しTrousseau症候群による凝固機能異常が原因と考えた。化学療法5コース終了後に胃全摘術を施行し,その後はレジメンをS-1+docetaxel(DTX),さらにnab-paclitaxel(PTX)に変更し化学療法を継続した。内服抗凝固療法にて脳梗塞の再発は認めなかったが,原疾患の悪化に伴い術後1年5か月で他界した。癌患者にみられる血液凝固能異常はTrousseau症候群として知られており,脳梗塞の合併頻度が高く予後不良である。担癌患者における血栓症においては,本疾患も念頭に置いて加療すべきであると考える。
目次
Summary
In October 2012, a man in his 60s was hospitalized for the examination of ascites, and was diagnosed with gastric cancer and carcinomatous peritonitis. S-1+cisplatin(CDDP)therapy was administered as neoadjuvant chemotherapy; however, during therapy, he developed cerebral infarction. We suspected that the cerebral infarction was caused by a coagulation disorder owing to Trousseau's syndrome. After completing 5 courses of chemotherapy, total gastrectomy was performed. Thereafter, the treatment was changed to S-1+docetaxel(DTX), followed by nab-paclitaxel(PTX). Although cerebral infarction did not relapse after the administration of an anticoagulant agent, the patient died of gastric cancer 1 year and 5 months after the operation. Trousseau's syndrome is a coagulation disorder in cancer patients. Cerebral infarctions caused by Trousseau's syndrome have a high tendency to relapse, and the prognosis is poor. This syndrome should be kept in mind when treating cancer patients.
要旨
症例は60歳台,男性。2012年10月,腹水貯留の精査を目的に入院し,胃癌およびそれによる癌性腹膜炎と診断された。術前化学療法としてS-1+cisplatin(CDDP)療法を開始したが,化学療法中に脳梗塞を発症しTrousseau症候群による凝固機能異常が原因と考えた。化学療法5コース終了後に胃全摘術を施行し,その後はレジメンをS-1+docetaxel(DTX),さらにnab-paclitaxel(PTX)に変更し化学療法を継続した。内服抗凝固療法にて脳梗塞の再発は認めなかったが,原疾患の悪化に伴い術後1年5か月で他界した。癌患者にみられる血液凝固能異常はTrousseau症候群として知られており,脳梗塞の合併頻度が高く予後不良である。担癌患者における血栓症においては,本疾患も念頭に置いて加療すべきであると考える。