[A case of gastric cancer with paraaortic lymph node metastasis responding to TS-1/CDDP combination therapy].

A 53-year-old man had consulted another physician regarding his epigastralgia and anorexia. Since gastric cancer was detected, he was referred to our department. An upper gastrointestinal endoscopy revealed a type-2 gastric cancer at the upper portion of the lesser curvature of the stomach, and an abdominal CT scan showed marked swelling of periaortic lymph nodes. Since a radical resection appeared impossible, we used preoperative chemotherapy with a combination of TS-1 and CDDP. The patient was administered TS-1 for 3 weeks at 120 mg/ day, received an intravenous drip infusion of 90 mg/body of CDDP on day 8, and then discontinued chemotherapy for 2 weeks, which was regarded as one course. After 2 courses of the chemotherapy, an upper gastrointestinal endoscopy showed that the primary tumor was reduced in size, the periphery of the tumor almost flattened, and an abdominal CT scan confirmed the loss of swelling in the periaortic lymph nodes. The responsive rate was evaluated as PR. Since a radical resection was considered possible, we performed a total gastrectomy with complete D3 extirpation combined with a splenectomy. Histological efficacy was evaluated as grade 2 in primary cancer, and grade 3 in lymph nodes. Regrettably, the patient died one year and 7 months postoperatively. However, we consider the TS-1 and CDDP in combination useful as preoperative chemotherapy for advanced gastric cancer with periaortic lymph node involvement.

[A case of gastric endocrine cell carcinoma with neck lymph node metastasis resected after neoadjuvant chemotherapy].

A relatively rare case of gastric endocrine cell carcinoma was reported. The prognosis of this disease appears to be very poor due to its rapid rate of growth and invasiveness. A 75-year-old woman underwent a gastric endoscopy because the patient complained of an appetite loss. A gross Borrmann 3 type lesion in the greater curvature of the fornix was found. Biopsy specimens showed endocrine cell carcinoma. Abdominal CT examination revealed metastases in left neck and paraaortic lymph nodes. The serum sample showed an elevation of NSE level to be 53. A combination chemotherapy was performed using cisplatin and etoposide, which resulted in remarkable reduction of the main tumor two months later. The total gastrectomy associated with D2 lymph node dissection was performed. However, abdominal tumor was observed again in a month and it progressed rapidly. No clear response to the chemotherapies with cisplatin/etoposide or paclitaxel was found. The patient died 5 months after the operation.