Sujet(s)
Transformation cellulaire néoplasique , Altération de l'ADN , Régulation de l'expression des gènes dans la leucémie , Leucémies/génétique , Leucémies/anatomopathologie , Syndromes myélodysplasiques/génétique , Syndromes myélodysplasiques/anatomopathologie , Cellules de la moelle osseuse/métabolisme , Histone/métabolisme , Humains , Immunohistochimie/méthodes , Perte d'hétérozygotie , MutationRÉSUMÉ
A 57 year-old man visited our hospital with general fatigue and a sensation of abdominal fullness. He had lost 10 kg in body weight during the previous 3 months. Between admission and the time the diagnosis of AFP-producing gastric carcinoma with multiple liver metastases was made, his condition deteriorated quickly due to the rapid growth of the liver metastases. Combined chemotherapy consisting of cisplatin and 5-FU was given, and was so effective that the patient recovered well and both serum AFP level and the size of the swollen liver decreased markedly. However, about a month after being discharged, he experienced a relapse and was readmitted. After obtaining informed consent, chemotherapy consisting of methotrexate and 5-FU was started. Though the level of tumor markers and LDH decreased significantly, he died of hepatic failure. We think that this case is worthy of notice because it shows the effectiveness and limitations of chemotherapy in a situation where the condition of a patient is deteriorating quickly due to rapid extension of an AFP-producing gastric carcinoma.
Sujet(s)
Adénocarcinome/traitement médicamenteux , Protocoles de polychimiothérapie antinéoplasique/usage thérapeutique , Tumeurs du foie/secondaire , Tumeurs de l'estomac/traitement médicamenteux , Alphafoetoprotéines/biosynthèse , Adénocarcinome/métabolisme , Adénocarcinome/secondaire , Cisplatine/administration et posologie , Fluorouracil/administration et posologie , Humains , Mâle , Adulte d'âge moyen , Tumeurs de l'estomac/métabolisme , Tumeurs de l'estomac/anatomopathologieRÉSUMÉ
Two patients with advanced hepatocellular carcinoma presented severe exertional dyspnea because of extension of a tumor into the right side of the heart. Removable of the tumor thrombus by open-heart surgery ameliorated the symptoms in each case, but their subsequent courses differed considerably. One patient survived for as long as 8 months thanks to successive multi-disciplinary treatments, whereas the other patient died suddenly 1 month after the surgery. The first patient's hepatocellular carcinoma was more differentiated, and the dyspnea was caused by a low cardiac output due to the intracardiac tumor mass, not by pulmonary embolism as in the second patient's case. We conclude that successive multidisciplinary treatments to control the growth of hepatocellular carcinoma is the most important approach and is indispensable for improving the prognosis.