演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

胃神経内分泌癌に対し胃全摘術, 肝部分切除術, 化学療法を併用し長期生存した1例

演題番号 : P110-5

[筆頭演者]
演者)植田 怜男:1 
[共同演者]
黒木 実智雄:1、伊藤 南:1、菊池 弘樹:1、名木野 匡:1、西瀬 雄子:1、平川 秀紀:1

1:山形市立病院済生館・消化器内科

 

A 72-year-old man presented with melena. Upper gastrointestinal endoscopy revealed a tumor on the cardia of stomach. He was diagnosed as neuroendocrine cell carcinoma (NEC) by biopsy specimens. Computed tomography (CT) showed swollen lymph nodes located close to the tumor and no evidence of distant metastasis. The patient underwent total gastrectomy and D2 lymphadenectomy. The pathological examinations showed the tumor was pure neuroendocrine carcinoma with no adenocarcinoma element. Immunohistochemically, the tumor cells were positive for synaptophysin, CD56, and CEA. The Ki-67 labeling index was 70. A month after the surgery, CT revealed a liver metastasis. The patient received chemotherapy with irinotecan and cisplatin in accordance with the standard treatment for small cell lung cancer. After 3 courses, the metastasis was reduced in size. We performed partial hepatectomy for the metastasis, but CT revealed another liver metastasis a month later. It didn't decrease in size though he had been treated by chemotherapy of irinotecan and cisplatin again. We therefore performed radiofrequency ablation to the metastasis, but multiple liver metastases were found. He received chemotherapy of ramucirumab and paclitaxel, and it was successfully performed without progression for 13 months after the treatment. He received chemotherapies of S-1 plus oxaliplatin, nivolmab, and nab-paclitaxel in turn because CT had shown liver metastases and enlarged lymph nodes. He died 39 months after the gastrectomy. The prognosis of NEC is bad, and there is no standard chemotherapy. The efficacy of the ramucirumab plus paclitaxel regimen for gastric NEC has been reported. In this case, it seems that the regimen is also effective for gastric NEC.

キーワード

臓器別:NET(神経内分泌腫瘍)

手法別:化学療法

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