[A case of primary gastric choriocarcinoma].

Primary gastric choriocarcinoma is an extremely rare and poor prognosis. A 73-year-old man who had appetite loss was admitted to our hospital in May 2006. Abdominal CT showed tumor measured 9x7 cm in size between residual stomach and pancreas. Gastrointestinal endoscopy revealed that gastric posterior wall was compressed and soft necrotic elevated tissue with coagulation. Endoscopic biopsy specimens showed poorly differentiated adenocarcinoma. Total gastrectomy with D2 lymphadenectomy, distal pancreatectomy, splenectomy, and partial resection of transverse colon were performed. Histological findings of resected specimens showed choriocarcinoma which demonstrated reactivity against anti-hCG antibody by immunohistochemical staining. Forty five days after the operation, skin metastasis appeared, and he died of this disease 60 days after the operation.

[A surgical case of recurrent gastric cancer successfully treated by TS-1 plus low-dose consecutive administration of CDDP following TS-1 monotherapy].

The patient was a 65-year-old woman who was discovered to have recurrent gastric cancer involving para-aortic lymph nodes 21 months after postoperative low-dose FP therapy for gastric cancer. The recurrent cancer was judged to be unresectable, and TS-1 chemotherapy (one course consisting of 4-week administration of 100 mg/day and a 2-week withdrawal period) was performed. Although a complete response occurred in the para-aortic lymph nodes and a partial response in the residual stomach (i.e., only a shallow erosion remained) after the end of course 2, histological examination showed "no change". The following regimen was therefore used in courses 3 and 4: 6-day administration of CDDP at a dose of 15 mg/body (10 mg/m2)/day the first week, concomitant administration of 90 mg/body (60 mg/m2) of CDDP plus 100 mg/day of TS-1 the next three weeks, and two-week withdrawal of chemotherapy. Since down-staging was observed at the completion of course 4, total gastrectomy of the residual stomach was performed. No noteworthy adverse reactions to chemotherapy were observed, and good patient QOL (e.g., appetite) was achieved. Based on these findings, this chemotherapy regimen appears to be an effective treatment modality for far advanced gastric cancer, particularly involving the abdominal para-aortic lymph nodes.