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Background : Leptomeningeal carcinomatosis (LMC) is a rare complication of gastric cancer. Case 1. A 57-year-old female was diagnosed with gastric cancer and underwent distal gastrectomy with D2 lymph... node dissection. Two years later, the patient suffered from para-aortic lymph node metastases and provided chemotherapy. During the chemotherapy, the patient emergently visited our hospital with chief complaints of a severe headache and dizziness. The above symptoms promptly abated by meningeal drainage, with a high value of the cerebrospinal fluid (CSF) pressure. Despite the administration of subsequent chemotherapy, the patient's clinical state rapidly worsened, including gradual progression of both blindness and hearing loss. Case 2. A 42-year-old male was diagnosed with Stage IV gastric cancer due to both distant lymph node metastases and an ascites. Chemotherapy with S-1 plus docetaxel was initiated. Upon finishing the fifth course of treatment, the patient complained of a severe headache. The magnetic resonance imaging (MRI) findings were suggestive of LMC. Under suspicion of carcinomatous meningitis, the patient underwent both cerebrospinal drainage with a high pressure value of 180 mmH2O and a cytological examination with a diagnosis of Class V. Immediately following the cerebrospinal drainage, the patient's symptoms promptly diminished. Case 3. A 66-year-old female was diagnosed with gastric cancer and underwent total gastrectomy with D2 dissection. About a year later, the patient suffered from the peritoneal dissemination, and provided serial chemotherapy regimens for 13 months. Thereafter the patient suffered from mildly stiff shoulders followed by serial severe headaches, and meningeal drainage was performed. The CSF showed pleocytosis and the presence of neoplastic cells, leading a diagnosis of LMC. After the placement of an Ommaya reservoir, the intrathecal chemotherapy was performed. Within two weeks of treatment, the patient's condition improved significantly, and the cell counts in the CSF obtained from the Ommaya reservoir remained low for six months after the first diagnosis of LMC. Conclusions : Although gastric LMC-affected patients often exhibit a fatal clinical course, the administration of intrathecal chemotherapy may improve survival. Systemic chemotherapy may be also administered in a limited number of patients with a superior performance status. At present, each case requires the individual making treatment decisions. Further accumulation of clinical cases and improving the overall understanding of the pathogenesis of this disease is needed in order to advance in the treatment of gastric LMC.
3 例の胃癌髄膜癌腫症を報告する．症例1 は50 歳代，女性．胃癌の診断で幽門側胃切除術施行された2年後に傍大動脈リンパ節転移に再発を来たし5-FU + paclitaxel による一次化学療法を開始された．治療継続中に頭痛と眩暈が出現し，細胞診を含む精査の結果，高髄液圧(580mmH2O)を伴う髄膜癌腫症と診断された．髄液ドレナージにて症状は改善したが，一次治療はPDと判断し，二次治療としてmethotrexate + 5-FU に移行した．しかし病勢は急激に進行し，全盲および聴覚障害に至った．症例2 は40歳代，男性．腹膜播種と遠隔リンパ節転移を伴うStage IV 胃癌に対してS-1 + docetaxel による化学療法施行中であったが，5 コース終了後に激しい頭痛が出現した．MRI 上，脳実質表面の髄膜の異常増強所見から髄膜癌腫症が疑われ，髄液細胞診および高髄液圧（180mmH2O）にて診断確定に至った．髄液ドレナージにて症状は改善したが，その後原発巣の穿孔による汎発性腹膜炎を発症した．症例3 は60 歳代，女性．胃癌の診断で胃全摘術を施行され，術後補助化学療法は有害事象で早期に中止されていた．術後1 年3ヶ月で腹膜播種再発を来たし，S-1 + docetaxel による一次治療，化学療法開始5ヶ月後からirinotecanによる二次治療が継続されていた．治療開始後1 年1ヶ月の時点でPR であったが，同時期に両肩の強ばりに引き続く激しい頭痛を訴え，髄膜炎が疑われた．髄液圧は正常であったが，髄液ドレナージにて症状は軽快し，髄液細胞診にてClass Vであった．二次治療PD かつ癌性髄膜炎の診断で，Ommaya リザーバーを留置してmethotrexateによる髄腔内化学療法を開始したところ，症状は改善し，約6ヶ月間，同治療を継続可能であった．続きを見る
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