内容紹介
A Case of AFP-Producing Gastric Cancer with Peritoneal Metastasis Treated Effectively with Chemotherapy, Mainly Using S-1 and Trastuzumab
Summary
A 71-year-old man, diagnosed with advanced gastric cancer and severe pyloric stenosis, was introducted to our hospital. Para-aortic lymph nodes metastasis and pancreas invasion were seen with enhanced CT scan. Serum AFP showed a high price(1,465.3 ng/mL). Because significant peritoneal metastases were seen in the abdominal cavity, gastrojejunostomy was performed. Overexpression of the HER2 gene was seen by immunostaining for peritoneal dissemination of the omentum. After starting S-1+CDDP+trastuzumab, the AFP was normalized immediately(7.6 ng/mL). We then performed colostomy for a sigmoid colon stenosis. S-1+DOC+trastuzumab was administered afterward, and we performed closure of the colostomy because the stenosis was improved. Macroscopic peritoneal dissemination in the abdomen disappeared. AFP-producing gastric cancer with peritoneal metastasis has a poor prognosis, but chemotherapy, mainly with S-1 and trastuzumab, was effective for it.
要旨
症例は71歳,男性。嘔吐の精査で幽門狭窄を伴う進行胃癌と診断され,当科紹介となった。造影CTでは膵浸潤,傍大動脈リンパ節転移を認め,血液検査でAFPが1,465.3 ng/mLと高値を示した。切除不能進行胃癌と診断し,胃空腸吻合術を行った。腹腔内全体に著明な腹膜転移を認め,播種巣の病理検査でHER2が過剰発現を示した。S-1+CDDP+trastuzumabを開始したところ,早期にAFPは7.6 ng/mLと正常化した。その後,S状結腸狭窄に対し人工肛門造設術を施行。以後S-1+DOC+trastuzumabを行い,狭窄が改善したため人工肛門閉鎖術を施行した。腹腔内に播種巣はみられず,瘢痕を認めるのみであった。治療開始後8か月経過した現在は,外来でS-1+trastuzumabを行っている。腹膜転移陽性胃癌,AFP産生胃癌はともに予後不良とされるが,今回われわれはS-1とtrastuzumabを用いた化学療法が著効した1例を経験したため報告する。
目次
Summary
A 71-year-old man, diagnosed with advanced gastric cancer and severe pyloric stenosis, was introducted to our hospital. Para-aortic lymph nodes metastasis and pancreas invasion were seen with enhanced CT scan. Serum AFP showed a high price(1,465.3 ng/mL). Because significant peritoneal metastases were seen in the abdominal cavity, gastrojejunostomy was performed. Overexpression of the HER2 gene was seen by immunostaining for peritoneal dissemination of the omentum. After starting S-1+CDDP+trastuzumab, the AFP was normalized immediately(7.6 ng/mL). We then performed colostomy for a sigmoid colon stenosis. S-1+DOC+trastuzumab was administered afterward, and we performed closure of the colostomy because the stenosis was improved. Macroscopic peritoneal dissemination in the abdomen disappeared. AFP-producing gastric cancer with peritoneal metastasis has a poor prognosis, but chemotherapy, mainly with S-1 and trastuzumab, was effective for it.
要旨
症例は71歳,男性。嘔吐の精査で幽門狭窄を伴う進行胃癌と診断され,当科紹介となった。造影CTでは膵浸潤,傍大動脈リンパ節転移を認め,血液検査でAFPが1,465.3 ng/mLと高値を示した。切除不能進行胃癌と診断し,胃空腸吻合術を行った。腹腔内全体に著明な腹膜転移を認め,播種巣の病理検査でHER2が過剰発現を示した。S-1+CDDP+trastuzumabを開始したところ,早期にAFPは7.6 ng/mLと正常化した。その後,S状結腸狭窄に対し人工肛門造設術を施行。以後S-1+DOC+trastuzumabを行い,狭窄が改善したため人工肛門閉鎖術を施行した。腹腔内に播種巣はみられず,瘢痕を認めるのみであった。治療開始後8か月経過した現在は,外来でS-1+trastuzumabを行っている。腹膜転移陽性胃癌,AFP産生胃癌はともに予後不良とされるが,今回われわれはS-1とtrastuzumabを用いた化学療法が著効した1例を経験したため報告する。