Sažetak
Uvod. Istovremeni karcinom želuca i debelog creva javlja se kod 4% bolesnika, obično kao uzgredan nalaz. Prikazali smo primer invazivnog, sinhronog karcinoma želuca i sigmoidnog kolona. Prikaz bolesnika. Bolesnik, star 63 godine, primljen je u našu ustanovu zbog bola u epigastrijumu, povraćanja, naglog gubitka telesne mase i povremene opstipacije. Ezofagogastroduodenoskopijom (EGDS) verifikovan je ulceroinfiltrativni tumor fundusa želuca, a kolonoskopski stenozirajući tumor sigmoidnog kolona. Multislajsnom kompjuterizovanom tomografijom (MSCT) grudnog koša i abdomena utvrđeno je postojanje promene u desnom plućnom krilu. Videoskopskom torakoskopijom (VATS) i biopsijom promene desnog pluća isključena je diseminacija. Učinjena je totalna gastrektomija sa omentektomijom, splenektomijom, D2 limfadenektomijom i tipična leva hemikolektomija. Patohistološkim pregledom verifkovan je invazivni, difuzni adenokarcinom želuca i invazivni, tubularni adenokarcinom kolona. Primenjena je sistemska postoperativna hemoterapija. Bolesnik je živ, bez znakova recidiva, 2 godine posle operacije. Zaključak. Postojanje simptomatologije koja ne odgovara primarnom malignitetu zahteva dodatnu dijagnostiku. Kombinovana resekcija je adekvatna hirurška proceduraKljučne reči
multiple primary||
||neoplazme
multiple
primarne
stomach neoplasms||
||želudac
neoplazme
colonic neoplasms||
||kolon
diagnostic techniques and procedures||
||dijagnostičke tehnike i procedure
histology||
||histologija
digestive system surgical procedures||
||hirurgija digestivnog sistema
procedure
Reference
Koide N, Adachi W, Koike S, Watanabe H, Yazawa S, Amano J. Synchronous gastric tumors associated with esophageal cancer. Am J Gastroenterol 1998; 93(5): 758−62.
Chang YT, Tsai CI, Yang TH, Shih CW, Wu MS, Lin JT. Syn-chronous triple cancers at middle and lower esophagus and stomach with different histological features and genetic altera-tions. J Gastroenterol Hepatol 2002; 17(6): 724−7.
Onoue S, Katoh T, Chigira H, Matsuo K, Suzuki M, Shibata Y, et al. Synchronous multiple primary cancers of the stomach and duodenum in aged patients: report of two cases. Surg Today 2000; 30(8): 735−8.
Dinis-Ribeiro M, Lomba-Viana H, Silva R, Moreira-Dias L, Lomba-Viana R. Associated primary tumors in patients with gastric cancer. J Clin Gastroenterol 2002; 34(5): 533−5.
Tamura M, Shinagawa M, Funaki Y. Synchronous triple early cancers occurring in the stomach, colon and gallbladder. Asian J Surg 2003; 26(1): 46−8; discussion 49.
Sato K, Maekawa T, Yabuki K, Tamasaki Y, Maekawa H, Kudo K, et al. A case of triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas. J Gastroenterol 2003; 38(1): 97−100.
Laurén P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand 1965; 64: 31−49.
Watanabe S, Kodama T, Shimosato Y, Arimoto H, Sugimura T, Suemasu K, et al. Multiple primary cancers in 5,456 autopsy cas-es in the National Cancer Center of Japan. J Natl Cancer Inst 1984; 72(5): 1021−7.
Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and statistical study. Am J Cancer 1932; 16: 1385–414.
Lee JH, Bae JS, Ryu KW, Lee JS, Park SR, Kim CG, et al. Gastric cancer patients at high-risk of having synchronous cancer. World J Gastroenterol 2006; 12(16): 2588−92.
Saito S, Hosoya Y, Togashi K, Kurashina K, Haruta H, Hyodo M, et al. Prevalence of synchronous colorectal neoplasms detected by colonoscopy in patients with gastric cancer. Surg Today 2008; 38(1): 20–5.
Šipetić Grujičić S, Krivokapić Z. Epidemiological and etiological characteristics of colon and rectal cancer. In: Krivokapić Z, editor. Rectal cancer. Belgrade: Zavod za udžbenike; 2012. p. 37−55. (Serbian)
Nakajima T. Gastric cancer treatment guidelines in Japan. Gas-tric Cancer 2002; 5(1): 1−5.
Maruyama K, Okabayashi K, Kinoshita T. Progress ingastric cancer surgery in Japan and its limits of radicality. World J Surg 1987; 11(4): 418–25.
Eom BW, Lee HJ, Yoo MW, Cho JJ, Kim WH, Yang HK, et al. Synchronous and metachronous cancers in patients with gas-tric cancer. J Surg Oncol 2008; 98(2): 106−10.
Kim JP, Park JG. Results of treatment of stomach cancer. J Korean Med Assoc 1983; 26: 637–42.
Ikeda Y, Saku M, Kawanaka H, Nonaka M, Yoshida K. Features of second primary cancer in patients with gastric cancer. On-cology 2003; 65(2): 113−7.
Lei Z, Zhao H, Liang D. Clinical analysis of 13 cases of syn-chronous gastricand colorectal cancer. Chinese German J Clin Oncol 2007; 6(4): P331–3.
Mylonakis E, Κlimis A, Vlachos G, Glynatsis M. Glynatsis. Syn-chronous Colon and Advanced Gastric Cancer. Hellenic J Surg 2012; 84: 5.
Ohtani H, Yashiro M, Onoda N, Nishioka N, Kato Y, Yamamoto S, et al. Synchronous multiple primary gastrointestinal cancer ex-hibits frequent microsatellite instability. Int J Cancer 2000; 86(5): 678−83.
Ikeguchi M, Ohfuji S, Oka A, Tsujitani S, Maeda M, Kaibara N. Synchronous and metachronous primary malignancies in or-gans other than the stomach in patients with early gastric can-cer. Hepatogastroenterology 1995; 42(5): 672−6.
Kaibara N, Maeta M, Ikeguchi M. Patients with multiple primary gastric cancers tend to develop second primaries in organs other than the stomach. Surg Today 1993; 23(2): 186−8.