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━━ Background. Gastric metastasis of primary lung cancer is relatively rare. However, reports of this condition have increased in recent years. Gastric metastatic lesions have the potential to influence the course of treatment and quality of life. Hence, physicians must appropriately examine the treatment options on a case-bycase basis. Case Study. A 65-year-old male diagnosed with adenocarcinoma of the right superior lobe underwent resection of the right superior lobe. One year and four months after the surgery, he was diagnosed with a gastric metastatic tumor related to lung carcinoma. He was started on systemic chemotherapy and subsequently suffered from gastric perforation twice during the course of treatment. The first perforation was treated nonsurgically, while the second was treated surgically. Conclusion. In Japan, there are approximately 30 previous reports of cases of comorbid gastric metastasis in which the patient underwent surgery. Among these cases, almost all of the patients exhibited severe clinical symptoms. Identifying asymptomatic cases and determining the timing and indications for surgery for metastatic lesions are difficult problems that must be discussed adequately. (JJLC. 2015;55:24-29) KEY WORDS━━ Lung adenocarcinoma, Gastric metastasis, Gastric perforation Received July 4, 2014; accepted January 16, 2015. 要旨━━背景.原発性肺癌の胃転移は比較的稀である が,近年その報告数が増加している.胃転移巣はその後 の治療経過やQOLに大きな影響を及ぼす可能性があ り,治療方針を症例毎に慎重に検討する必要がある.症 例.症例は 65 歳男性.右肺上葉腺癌の術後 1年 4か月 後,CTにて胃小弯リンパ節腫大,CEA上昇を指摘され 上部消化管内視鏡検査が施行された.胃体上部前壁に粘 膜下腫瘍様の隆起性病変を指摘され,病理組織学的検索 の結果,肺腺癌胃転移の診断となった.その後全身化学 療法が施行されたが,経過中 2度の胃穿孔を併発した. 1回目は保存療法を行い,2回目は開腹手術を行った.結 論.原発性肺癌の胃転移の転移巣切除報告例は本邦では 30 例であり,出血や穿孔などの有症状例において手術が 行われている例が多い.無症状の場合には,転移巣切除 の適否や時期についての十分な検討が必要である. 索引用語━━肺腺癌,胃転移,胃穿孔

Gastric Perforation Occurring Twice During Chemotherapy for Lung Adenocarcinoma Metastasis