内容紹介
A Case of Esophageal Squamous Cell Carcinoma with an Adenocarcinoma Component That Dedifferentiated after Chemotherapy
Summary
Case: A 69-year-old man was diagnosed with advanced esophageal cancer(well-differentiated squamous cell carcinoma). Neoadjuvant chemotherapy consisting of nedaplatin and 5-fluorouracil(5-FU)was initiated. After two courses of chemotherapy, the patient was judged to have achieved a clinical complete response. The patient then decided against undergoing surgery and opted instead to continue with the chemotherapy, receiving five courses in total. However, the esophageal cancer recurred, and subtotal esophagectomy was performed in January 2011. Squamous cell carcinoma with an adenocarcinoma component, which consisted of poorly differentiated squamous cell carcinoma and tubular adenocarcinoma cells, was observed at the primary site. Metastasis of the cancer to the liver was detected 2 months after surgery. The subsequent administration of four courses of docetaxel to the patient did not result in any beneficial effects, and the patient developed carcinomatous pleurisy and died of this complication in November 2011. The patient survived for a total of 21 months after starting chemotherapy. In this case, the chemotherapy itself may have resulted in the dedifferentiation of a well-differentiated squamous cell carcinoma to result in a poorly differentiated squamous cell carcinoma with an adenocarcinoma component.
要旨
症例: 進行食道癌(高分化扁平上皮癌)の69歳,男性。術前化学療法2コース後にCRと判定した。患者は化学療法の継続を希望し,計5コースを行った。その後,局所に再燃を認め食道亜全摘術を行った。手術標本では,低分化扁平上皮癌と管状型腺癌で構成されたsquamous cell carcinoma with adenocarcinoma componentを確認した。術後2か月目に肝転移がみられ,docetaxel療法を行ったが効果はなく癌性胸膜炎により死亡した(全生存期間21か月)。本症例は,高分化扁平上皮癌が化学療法後により腺癌を含む低分化扁平上皮癌に脱分化したと考えられた。
目次
Summary
Case: A 69-year-old man was diagnosed with advanced esophageal cancer(well-differentiated squamous cell carcinoma). Neoadjuvant chemotherapy consisting of nedaplatin and 5-fluorouracil(5-FU)was initiated. After two courses of chemotherapy, the patient was judged to have achieved a clinical complete response. The patient then decided against undergoing surgery and opted instead to continue with the chemotherapy, receiving five courses in total. However, the esophageal cancer recurred, and subtotal esophagectomy was performed in January 2011. Squamous cell carcinoma with an adenocarcinoma component, which consisted of poorly differentiated squamous cell carcinoma and tubular adenocarcinoma cells, was observed at the primary site. Metastasis of the cancer to the liver was detected 2 months after surgery. The subsequent administration of four courses of docetaxel to the patient did not result in any beneficial effects, and the patient developed carcinomatous pleurisy and died of this complication in November 2011. The patient survived for a total of 21 months after starting chemotherapy. In this case, the chemotherapy itself may have resulted in the dedifferentiation of a well-differentiated squamous cell carcinoma to result in a poorly differentiated squamous cell carcinoma with an adenocarcinoma component.
要旨
症例: 進行食道癌(高分化扁平上皮癌)の69歳,男性。術前化学療法2コース後にCRと判定した。患者は化学療法の継続を希望し,計5コースを行った。その後,局所に再燃を認め食道亜全摘術を行った。手術標本では,低分化扁平上皮癌と管状型腺癌で構成されたsquamous cell carcinoma with adenocarcinoma componentを確認した。術後2か月目に肝転移がみられ,docetaxel療法を行ったが効果はなく癌性胸膜炎により死亡した(全生存期間21か月)。本症例は,高分化扁平上皮癌が化学療法後により腺癌を含む低分化扁平上皮癌に脱分化したと考えられた。