内容紹介
Summary
A 70-year-old man with epigastralgia who initially visited a local hospital was referred to us for further examination. Gastrointestinal endoscopy exhibited a type 3 tumor of the stomach from the body to the antrum(adenocarcinoma, por1). Contrast-enhanced CT revealed thickness in the wall of the gastric body with bulky lymph nodes and ascites. Staging laparoscopy showed that the patient was diagnosed with sStage Ⅳ gastric cancer with positive peritoneal cytology. Therefore, SOX therapy was administered. Subsequently, total gastrectomy with D2 lymph node dissection was performed, since the primary tumor and lymph nodes were significantly reduced. Histopathologically, the residual lesion was only observed in the mucosal layer without lymph node metastases. We herein report a case of Stage Ⅳ gastric cancer, which was successfully treated by conversion surgery after SOX therapy.
要旨
症例は70歳,男性。食思不振,心窩部痛で前医より当院消化器内科へ紹介入院した。上部消化管内視鏡検査にて胃癌(por1,HER2陰性)を認め,当科紹介となった。腹部造影CTで胃壁の肥厚,bulkyリンパ節の腫大および腹水を認めた。審査腹腔鏡を施行し,腹水細胞診陽性でsT4aN3M1(Cy1),sStage Ⅳの診断となった。SOX療法を6コース後,腹部CTで原発およびリンパ節の著明な縮小効果を認めた。したがって,腹水細胞診陰性を確認後,胃全摘術を施行した。病理診断は胃粘膜にわずかに癌細胞を認めるのみで,組織学的治療効果はGrade 2bであった。今回われわれは,腹水細胞診陽性胃癌に対してSOX療法が著効し,conversion surgeryが可能となった1例を経験したので文献的考察も含めて報告する。
目次
A 70-year-old man with epigastralgia who initially visited a local hospital was referred to us for further examination. Gastrointestinal endoscopy exhibited a type 3 tumor of the stomach from the body to the antrum(adenocarcinoma, por1). Contrast-enhanced CT revealed thickness in the wall of the gastric body with bulky lymph nodes and ascites. Staging laparoscopy showed that the patient was diagnosed with sStage Ⅳ gastric cancer with positive peritoneal cytology. Therefore, SOX therapy was administered. Subsequently, total gastrectomy with D2 lymph node dissection was performed, since the primary tumor and lymph nodes were significantly reduced. Histopathologically, the residual lesion was only observed in the mucosal layer without lymph node metastases. We herein report a case of Stage Ⅳ gastric cancer, which was successfully treated by conversion surgery after SOX therapy.
要旨
症例は70歳,男性。食思不振,心窩部痛で前医より当院消化器内科へ紹介入院した。上部消化管内視鏡検査にて胃癌(por1,HER2陰性)を認め,当科紹介となった。腹部造影CTで胃壁の肥厚,bulkyリンパ節の腫大および腹水を認めた。審査腹腔鏡を施行し,腹水細胞診陽性でsT4aN3M1(Cy1),sStage Ⅳの診断となった。SOX療法を6コース後,腹部CTで原発およびリンパ節の著明な縮小効果を認めた。したがって,腹水細胞診陰性を確認後,胃全摘術を施行した。病理診断は胃粘膜にわずかに癌細胞を認めるのみで,組織学的治療効果はGrade 2bであった。今回われわれは,腹水細胞診陽性胃癌に対してSOX療法が著効し,conversion surgeryが可能となった1例を経験したので文献的考察も含めて報告する。