内容紹介
A Case of Malignant Peritoneal Mesothelioma with the Epithelioid Histological Type, Successfully Treated with Pemetrexed plus Cisplatin
Summary
A 45-year-old man presented with severe abdominal distention with massive ascites due to a diffusely disseminated peritoneal tumor. A core needle biopsy specimen was obtained from the peritoneal lesion. Histological diagnosis was epithelioid-type mesothelioma. He did not choose to receive chemotherapy. For 2.5 years, he went without medical intervention, and his disease gradually progressed, leading to a worsening of his symptoms. The patient then chose to be treated with combination chemotherapy of cisplatin and pemetrexed, followed by pemetrexed alone. There was remarkable tumor shrinkage and his symptoms improved. These effects have been sustained for two years after the initial chemotherapy. Chemotherapy appears to have contributed to survival prolongation for this patient. This case exemplifies the fact that malignant peritoneal mesothelioma may progress slowly when fits with some good prognostic factors, and it is important to consider the prognostic factors.
要旨
症例は45歳,男性。びまん性の腹膜播種と腹水を認め,針生検で上皮型悪性腹膜中皮腫と診断。積極的加療の希望なく経過観察となった。2.5年間,無治療で経過観察が可能であったが,腫瘍は徐々に増大し腹腔内を占拠したため全身状態が悪化した。シスプラチン(cisplatin: CDDP)+ペメトレキセド(pemetrexed: PEM)療法を行い,腫瘍の著明な縮小とともに全身状態の改善が得られた。さらにPEM単剤維持療法を行うことで,その後も増悪なく初回診断から4.5年間生存中である。また,本例はこれまで報告されている予後良好な因子をいくつか満たしており,予後因子を参考に治療介入時期などを検討できる可能性が示唆された。
目次
Summary
A 45-year-old man presented with severe abdominal distention with massive ascites due to a diffusely disseminated peritoneal tumor. A core needle biopsy specimen was obtained from the peritoneal lesion. Histological diagnosis was epithelioid-type mesothelioma. He did not choose to receive chemotherapy. For 2.5 years, he went without medical intervention, and his disease gradually progressed, leading to a worsening of his symptoms. The patient then chose to be treated with combination chemotherapy of cisplatin and pemetrexed, followed by pemetrexed alone. There was remarkable tumor shrinkage and his symptoms improved. These effects have been sustained for two years after the initial chemotherapy. Chemotherapy appears to have contributed to survival prolongation for this patient. This case exemplifies the fact that malignant peritoneal mesothelioma may progress slowly when fits with some good prognostic factors, and it is important to consider the prognostic factors.
要旨
症例は45歳,男性。びまん性の腹膜播種と腹水を認め,針生検で上皮型悪性腹膜中皮腫と診断。積極的加療の希望なく経過観察となった。2.5年間,無治療で経過観察が可能であったが,腫瘍は徐々に増大し腹腔内を占拠したため全身状態が悪化した。シスプラチン(cisplatin: CDDP)+ペメトレキセド(pemetrexed: PEM)療法を行い,腫瘍の著明な縮小とともに全身状態の改善が得られた。さらにPEM単剤維持療法を行うことで,その後も増悪なく初回診断から4.5年間生存中である。また,本例はこれまで報告されている予後良好な因子をいくつか満たしており,予後因子を参考に治療介入時期などを検討できる可能性が示唆された。