항문 주위 피부로 전이한 위암 1례 (A Case of Advanced Gastric Cancer with Solitary Perianal Metastasis)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 22권 / 2호 / 210 ~ 212페이지
· 저자명 : 최경현, 윤기영, 이상호

초록

Gastric adenocarcinoma can metastasize to various organ sites such as regional and distant lymph node(s), peritoneum, liver, ovary, lung, brain, bone, adrenal gland, skin and other sites via lymphatics and blood flow, or by direct seeding. But isolated perianal metastasis without other skin area involvement was rare and we could not find in the literature survey. So we are going to report this case; Patient was 48 year-old male with Borrmann type III adenocarcinoma(tubular poor type) located lesser curvature side of the Upper and Middle stomach invaded to underlying pancreas. He received total gastrectomy and Roux en Y gastrojejunostomy, distal pancreatectomy and splenctomy at Feb 26th 1999. Four out of 33 regional nodes were metastatic. He recovered farely well after operation and resumed work as full time farmer until Jul 11th 2003 follow up exams when he was diagnosed as multiple liver metastases. Tumor markers was as follow; CEA 5.2 ng/ml(he smokes a pack per day), CA 19-9 11.5 U/ml and urine pepsinogen 30.6 ng/ml(the pre-hepatic recurrence level was 8.1 ng/ml). He received 7 cycles of taxotere and cisplatin intravenous chemotherapy with complete remission on CT scan at Nov 18th 2003. Then he developed a metastatic perianal adenocarcinoma at May 4th 2004. It did not respond to radiation therapy. So it was completely resected out with two resection procedures and an end type sigmoid colostomy for fecal diversion. There are no recurrence until Jul 24th 2007 when he received IM injection of vitamin B12 and follow up exams. The tumor markers was normal limit including urine pepsinogen 11 g/ml. With this experience, all patients should be carefully followed up after gastric cancer operation for recurrence. Urine pepsinogen level can be a useful tumor marker after total gastrectomy for gastric adenocarcinoma. Don't give up patient with recurrences before various efforts to eradicate it.

영어초록

Gastric adenocarcinoma can metastasize to various organ sites such as regional and distant lymph node(s), peritoneum, liver, ovary, lung, brain, bone, adrenal gland, skin and other sites via lymphatics and blood flow, or by direct seeding. But isolated perianal metastasis without other skin area involvement was rare and we could not find in the literature survey. So we are going to report this case; Patient was 48 year-old male with Borrmann type III adenocarcinoma(tubular poor type) located lesser curvature side of the Upper and Middle stomach invaded to underlying pancreas. He received total gastrectomy and Roux en Y gastrojejunostomy, distal pancreatectomy and splenctomy at Feb 26th 1999. Four out of 33 regional nodes were metastatic. He recovered farely well after operation and resumed work as full time farmer until Jul 11th 2003 follow up exams when he was diagnosed as multiple liver metastases. Tumor markers was as follow; CEA 5.2 ng/ml(he smokes a pack per day), CA 19-9 11.5 U/ml and urine pepsinogen 30.6 ng/ml(the pre-hepatic recurrence level was 8.1 ng/ml). He received 7 cycles of taxotere and cisplatin intravenous chemotherapy with complete remission on CT scan at Nov 18th 2003. Then he developed a metastatic perianal adenocarcinoma at May 4th 2004. It did not respond to radiation therapy. So it was completely resected out with two resection procedures and an end type sigmoid colostomy for fecal diversion. There are no recurrence until Jul 24th 2007 when he received IM injection of vitamin B12 and follow up exams. The tumor markers was normal limit including urine pepsinogen 11 g/ml. With this experience, all patients should be carefully followed up after gastric cancer operation for recurrence. Urine pepsinogen level can be a useful tumor marker after total gastrectomy for gastric adenocarcinoma. Don't give up patient with recurrences before various efforts to eradicate it.

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