RESUMEN
Gastric mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) is an extremely rare form of gastric neoplasm, and its prognosis is often poor. This is a case report wherein the primary site increased during chemotherapy against gastric adenocarcinoma and was diagnosed with gastric MiNEN after total gastrectomy. A 71-year-old man was diagnosed with gastric adenocarcinoma complicated with liver and para-aortic lymph node metastasis. Chemotherapy with S-1, oxaliplatin, and trastuzumab was initiated. Although the size of metastatic lesions was reduced after six courses of treatment, a part of the primary site of gastric tumor rapidly. Pathological rebiopsy of the primary site suggested a neuroendocrine carcinoma, and he was finally diagnosed with gastric MiNEN after total gastrectomy. Thus, second-line chemotherapy was then initiated showing good response. We herein report a case of MiNEN with a rare diagnostic process.
Asunto(s)
Adenocarcinoma , Carcinoma Neuroendocrino , Tumores Neuroendocrinos , Neoplasias Gástricas , Masculino , Humanos , Anciano , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Tumores Neuroendocrinos/tratamiento farmacológico , Tumores Neuroendocrinos/diagnóstico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Carcinoma Neuroendocrino/terapia , BiopsiaRESUMEN
Small-cell carcinoma (SCC) of the esophagus is rare, and its clinical characteristics remain poorly understood. A 54-year-old man was given a diagnosis of esophageal SCC and underwent esophagectomy. Four months after surgery, he was admitted to our hospital because of rapidly developing hyponatremia. Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) due to extensive recurrence of SCC was diagnosed. Combined chemotherapy with irinotecan and cisplatin has dramatically reduced metastatic tumors, and it was concomitantly effective for SIADH. This case demonstrates that esophageal SCC could induce SIADH as a paraneoplastic syndrome and that the above combined chemotherapy was feasible and effective.
Asunto(s)
Carcinoma de Células Pequeñas/complicaciones , Neoplasias Esofágicas/complicaciones , Síndrome de Secreción Inadecuada de ADH/etiología , Síndromes Paraneoplásicos Endocrinos/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Carcinoma de Células Pequeñas/diagnóstico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Cisplatino/administración & dosificación , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/tratamiento farmacológico , Resultado Fatal , Humanos , Hiponatremia/etiología , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Irinotecán , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia/tratamiento farmacológico , Tumores Neuroendocrinos/complicaciones , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/tratamiento farmacológico , Síndromes Paraneoplásicos Endocrinos/tratamiento farmacológicoRESUMEN
The patient was a 69-year-old woman. She received chemotherapy and radiation for thyroid tumor (undifferentiated cancer) following an operation in 1998. The chemotherapy was regularly repeated for relapse. The tumor increased gradually and came to cause dysphagia. She initially rejected nutritional management that depends on intravenous hyper alimentation or gastrostomy. After receiving an informed consent, we performed percutaneous radio frequency ablation (RFA) for the tumor using a Cool-tip needle on April 2, 2003. The algorithm of RFA was 9 min: 30 --> 120 W, 12 min: 50 --> 110 W, 9 min: 50 --> 100 W. After 2 days, the covered stent was implanted in the esophagus and an oral intake was started. Although the operation for undifferentiated thyroid cancer is controversial, we performed RFA and esophageal stenting for improving of QOL. This is the first case report in Japan.