[A Case of Gastric Cancer with Mediastinal Lymph Node Recurrence Four Years after Surgery Despite Pathologically Complete Response to Preoperative Chemotherapy].

Q4 Medicine
Shigeyoshi Higashi, Haruna Furukawa, Tomohiro Takahashi, Shogo Yanagi, Yoko Oga, Nobuo Takiguchi, Yoshitoshi Ichikawa, Ryo Tsunashima, Yoshiaki Omura, Masakazu Miyake, Masaki Kashiwazaki, Masahiro Tanemura
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引用次数: 0

Abstract

A 71-year-old man was diagnosed with advanced gastric cancer of the upper body of the stomach by esophagogastroduodenoscopy. CT scan showed enlarged left supraclavicular fossa and mediastinal lymph nodes. U, type 4, cT4aN2M1 (LYM), Stage ⅣB was diagnosed and chemotherapy(SOX)was administered. After chemotherapy, the distant lymph nodes shrank and PET-CT scan showed no distant lymph node involvement. ycT1bN0M0, Stage Ⅰ was diagnosed. Laparoscopic total gastrectomy D2 dissection was performed as conversion surgery. Pathological findings were ypT0N0(0/34)M0 and histological response Grade 3. As postoperative adjuvant chemotherapy, S-1 was administered for about 1 year. The left supraclavicular fossa and mediastinal lymph nodes remained reduced and patients were followed up while imaging studies were performed. Four years post-operatively, the patient was diagnosed with recurrence due to elevated tumor markers and rapid enlargement of supraclavicular fossa and mediastinal lymph nodes. We experienced a case in which the patient had a pathological complete response but recurred 4 years after surgery.

[1例胃癌纵隔淋巴结术后4年复发,术前化疗病理完全缓解]。
患者71岁,经食管胃十二指肠镜检查诊断为胃上半身晚期胃癌。CT显示左侧锁骨上窝及纵隔淋巴结肿大。U, 4型,cT4aN2M1 (LYM),ⅣB期,给予化疗(SOX)。化疗后,远处淋巴结缩小,PET-CT扫描未见远处淋巴结受累。ycT1bN0M0,分期Ⅰ。腹腔镜全胃切除术D2夹层作为转换手术。病理结果为ypT0N0(0/34)M0,组织学反应3级。S-1作为术后辅助化疗,给药约1年。左侧锁骨上窝和纵隔淋巴结仍然缩小,患者在进行影像学检查的同时进行随访。术后4年,患者发现肿瘤标志物升高,锁骨上窝及纵隔淋巴结肿大,诊断为复发。我们经历了一个病例,病人有病理完全缓解,但术后4年复发。
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CiteScore
0.20
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