CA19-9-Producing Gastric Cancer with a Macroscopically CR to TS-1

Ichiro Sakamoto¹⁾, Fujio Makita¹⁾, Kenji Kashiwabara²⁾, Sumihiko Yoshimura¹⁾, Masaaki Higashi³⁾, Izumi Takeyoshi⁴⁾, Susumu Ohwada⁴⁾ and Yasuo Morishita⁴⁾

Department of Surgery, National Nishigunma Hospital¹⁾
Clinical Department of Pathology, Gunma University Hospital²⁾
Department of Surgery, National Hospital Kuryurakusenen³⁾
Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine⁴⁾

We report a case of CA19-9-producing gastric cancer having a macroscopically complete response (CR) to TS-1. A 77-year-old man with high serum CA19-9 seen in a routine health check had no definitive tumor found in CT, MRI, or upper and lower endoscopic examinations. Serum CA19-9 had increased rapidly, from 73.7 U/ml 6 months earlier to 38,650 U/ml. The calculated CA19-9 doubling time was 36.7 days. A third upper gastrointestinal endoscopic examination showed a giant irregular submucosal tumor in the lesser curvature of the body and fundus of the stomach. Biopsy specimens were diagnosed as poorly differentiated adenocarcinoma, which was positive for CA19-9, immunohistochemically. After TS-1 at 80 mg/day for 3 weeks, total gastrectomy was conducted with lymph node dissection. Neither tumor nor ulcer was seen in the resected specimen, although there was a shallow scar. A few cancer cells remained in the submucosal layer and degeneration with pyknotic cells, foamy cells, and calcification were seen microscopically. The macroscopic diagnosis was CR and a grade 2 response to chemotherapy microscopically. After surgery, serum CA19-9 decreased to with the normal range, and the patient is now well.

Key words
gastric cancer, TS-1, CA19-9

Reprint requests
Susumu Ohwada Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
3-39-15 Showa-machi, Maebashi, 371-8511 JAPAN

Accepted
September 22, 2004

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