Albumin-refractory Transudative Ascites for the Diagnosis of Protein-losing Gastric Cancer: A Case Report
10.14442/generalist.47.89
- VernacularTitle:アルブミン投与不応性の漏出性腹水から蛋白漏出性胃癌の診断に至った1例
- Author:
Naoya MIZUTANI
;
Hiroyuki MORI
;
Tsuneaki KENZAKA
- Keywords:
gastric cancer;
protein-losing;
99mTc-HSA scintigraphy
- From:An Official Journal of the Japan Primary Care Association
2024;47(3):89-98
- CountryJapan
- Language:Japanese
-
Abstract:
A 63-year-old man with schizophrenia presented to our hospital with a chief complaint of anorexia and edema in the lower legs for the past month. Upper gastrointestinal endoscopy revealed a gross type 3 gastric carcinoma (pathology: tubular adenocarcinoma, moderately differentiated type) from the upper gastric body to the gastric antrum. His serum total protein level was 4.7 g/dL and serum albumin concentration was 1.5 g/dL. Contrast-enhanced computed tomography, magnetic resonance imaging, and examination of ascites showed no evidence of distant metastases. Hypoalbuminemia was refractory to albumin administration with no evidence of cancerous peritonitis on staging laparoscopy. Gastrointestinal scintigraphy confirmed protein leakage from the gastric tumor into the gastrointestinal tract. We reviewed the literature and identified 34 other cases of protein-losing gastric cancer, which were used to comprehensively elucidate its clinical features. Borrmann type 0 or 1 tumors of the gastric body or antecubital area, with a maximum tumor diameter of nearly 10 cm and a cauliflower-like appearance, are highly suggestive of protein-losing gastric cancer. In conclusion, 99mTc-HSA scintigraphy and staging laparoscopy should be performed aggressively to differentiate protein-losing gastric cancer tumor from cancerous peritonitis.
