Abstract
The patient was a 68-year-old man who received a cadaveric donor liver transplantation for cirrhosis due to chronic hepatitis C and hepatocellular carcinoma in the USA in 2009 and thereafter had been administered an immunosuppresant in Japan. In 2011, a screening abdominal CT scan detected wall thickening of the stomach. Upper gastrointestinal endoscopy revealed type 2 advanced cancer on the lesser curvature of the stomach from the angular to pyloric antrum. Based on preoperative imaging findings, we considered the transplanted hepatic vessel to have probably been anastomosed at the level of the common hepatic artery, and performed distal gastrectomy (D1+) carefully not to injure the graft vessel. During surgery we identified firm adhesions in the lateral segment of the liver which were suggestive of direct invasion to the liver. Partial hepatectomy was thus employed. The histopathological diagnosis was pT3 (SS), N1, Stage IIIA without hepatic invasion. Adjuvant chemotherapy was withdrawn because of serious adverse side effects. The patient has been free from recurrence as of two years after the operation for gastric cancer.
The use of immunosuppresants after organ transplantation might participate in the onset of malignant neoplasm. It is predicted that a further increase in the number of long-term survivors after transplantation will increase the number of cases of post-transplant malignant disorder.
