[A case of advanced gastric cancer with portal vein thrombus leading to liver metastases].
A 68-year-old man presenting with anorexia was admitted to our hospital; he was diagnosed with pyloric stenosis arising from a type 3 tumor in the antrum of the stomach. Pathological examination revealed a poorly differentiated adenocarcinoma; immunohistochemical staining tested positive for alpha fetoprotein(AFP), and negative for human epidermal growth factor receptor 2(HER2). Abdominal computed tomography (CT) showed a portal vein thrombus and enlarged lymph nodes. Since the clinical finding was Stage IV(T4aN3M1), curative surgery was ruled out. Following stent placement for food intake, TS-1 plus cisplatin (CDDP) neoadjuvant chemotherapy was initiated. TS-1(80 mg/m² / day) was administered orally for 2 weeks followed by a drug-free 1-week period, and CDDP (60 mg/m²) was administered intravenously on day-1 as 1 course. After 5 courses of this regimen, lymph nodes were reduced in size and the portal vein thrombus disappeared. However, grade 4 thrombocytopenia was observed, and the treatment schedule was modified to include several other chemotherapies. Two years after the initiation of chemotherapy, liver metastasis was detected via elevated AFP. The patient died 27 months after initial treatment. Although the prognosis for gastric cancer with portal vein thrombus is very poor, it is possible to prolong survival with multimodality therapy.
Dept. of Surgery, Suita Municipal Hospital.
Chikara
C
Ebisui
Kazuyuki
K
Okada
Tetsu
T
Yanagisawa
Shu
S
Okamura
Nariaki
N
Fukuchi
Kohei
K
Murata
Hideoki
H
Yokouchi
Masamitsu
M
Tamai
Masakatsu
M
Kinuta
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D011169:Portal Vein / Q000473:pathology*; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy