Authors: Masahiko Kawaguchi Yasuyuki Asada Takuro Terada Akira Takehara Yoshinori Munemoto Katsunori Fujisawa Takeshi Mitsui Yoshiro Iida Shoji Miura Yoshiko Sudo
Publish Date: 2010/02/24
Volume: 15, Issue: 2, Pages: 191-195
Abstract
A 62yearold Japanese man presented with a 1month history of interdigestive epigastralgia His family history included a sister with gastric cancer Gastroendoscopy and gastrography demonstrated a type2 tumor in the upper region of the stomach CT scan and fluorodeoxyglucose–positron emission tomography FDG–PET scan demonstrated gastric cancer and its metastatic lymph nodes The patient underwent total gastrectomy with splenectomy and extended lymph node dissection Although postoperative adjuvant chemotherapy by S1 was started the deteriorating condition of the patient prevented drug administration and even eating meals On the 19th postoperative day POD FDG–PET scan of the body demonstrated new uptake in the liver and lymph node around the aorta Without any sign of infection leukocytosis developed around the 30th POD On the 49th POD remarkable uptake in the whole upper abdomen was detected on FDG–PET scan Finally leukocyte count increased to 125200 and granulocyte colony stimulating factor GCSF was elevated to 28 pg/ml on the 54th POD The patient died of multiple liver metastases and carcinomatous peritonitis only 56 days after surgery GCSFproducing tumor is a rare but aggressive disease particularly as recurrent tumor If leukocytosis is detected in relation to a nonlympho hematopoietic malignant tumor GCSFproducing tumor should be considered and FDG–PET scan is recommended for early detection Chemotherapy for GCSFproducing tumor must be conducted as soon as possible
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