2022 Volume 55 Issue 2 Pages 82-90
We report a case of multiple gastric cancer with a simultaneous solitary cerebral metastasis. A 69-year-old male visited another hospital complaining of amnesia, agraphia, and dysphasia. Cranial MRI revealed a multilocular tumor of 30 mm in diameter in the left parietal lobe of the cerebrum. He was urgently transferred to our hospital for further examination. Thoracoabdominal and pelvic CT showed no other abnormalities, but serum CEA and CA19-9 were markedly elevated to 1,052 ng/ml and 1,736 U/ml, respectively. Gastrointestinal endoscopic findings revealed [1] 0-IIc+IIa-type (cT1a) and [2] advanced 0-IIc-type (cT2) tumors in the lesser curvature of the upper gastric body and on the anterior wall of the antrum, respectively. First, cerebral metasectomy and postoperative intensity modulated radiation therapy (IMRT: 45 Gy) were performed. After IMRT, ESD with curative resection was performed for the 0-IIc+IIa-type early cancer in the upper gastric body, and laparoscopic distal gastrectomy (LDG) with D2 lymph node dissection and Billroth-I reconstruction were used for the advanced 0-IIc-type cancer in the antrum. Pathological examination revealed [1] U, Less, 0-IIc+IIa, tub1>tub2, pT1a, ly0, v0; [2] L, Ant, 0-IIc, tub1-2/por2, pT1b2, ly1a, v1a, pN1 (#3), H0, P0, pM1 (brain), pStage IV. Adjuvant chemotherapy was not administered after gastrectomy. The patient is currently alive with no sign of recurrence for 30 months since the cerebral metasectomy.
