内容紹介
Asymptomatic Longterm Survival in a Patient with Sigmoid Colon Lymph Node Metastasis with Cancerous Ascites of Unknown Origin
Summary
A 63-year-old man bearing a palpable tumor had a lymph node metastasis adjacent to the sigmoid colon that was detected by computed tomography and positron emission tomography. The sigmoid colon and enlarged lymph nodes were surgically resected, and cancerous ascites were present. Pathologically, the tumor in the lymph node was a poorly-differentiated adenocarcinoma that was positive for CA19-9 as well as CK7(-/+), CK20(+/-), VEGF(+), p 53(+)and MIB-1(>10%). We treated this case as a pancreatic or bile duct carcinoma due to the patient's markedly elevated serum levels of CA19-9 and SPan-1. However, we could not make a conclusive diagnosis. Gemcitabine-based chemotherapy was administered, and the patient had no signs of recurrence for 24 months after the operation. Then, a recurrence was identified by imaging studies, and the chemotherapy was changed to paclitaxel and carboplatin. The patient had stable disease until tumor regrowth was identified 38 months after the operation, chemotherapy was then stopped. However, at 48 months after the operation, the patient remains well and has no symptoms. Our case suggests that surgery and the appropriate choice of anti-cancer drugs may contribute to the long-term survival of patients with cancer of an unknown primary origin.
要旨
症例は63歳,男性。S状結腸間膜の腫瘍に対し開腹手術を施行。癌性腹水を伴っており,姑息的にリンパ節を含むS状結腸を切除した。病理診断では低分化型腺癌であった。病理学的にも臨床的にも原発は特定できなかったが,免疫染色にてCA19-9が陽性を示したことなどを総合的に判断し,膵癌に準じた治療を行うこととした。gemcitabineをベースとした化学療法で術後24か月間無症状,無再発で経過したが,尿管剥離面より局所再発を来したため,paclitaxel+carboplatinに切り替え治療を継続した。しかし術後38か月でprogressive disease(PD)となり以後無治療にて経過観察しているが,術後48か月現在無症状にて生存中である。原発不明癌の原発巣推定,治療方針の決定に免疫組織化学的検索が極めて有用であり,予後不良群の原発不明癌に対しても腫瘍減量手術と適切な化学療法の選択にて,長期生存を得られる可能性があることを示唆する症例である。
目次
Summary
A 63-year-old man bearing a palpable tumor had a lymph node metastasis adjacent to the sigmoid colon that was detected by computed tomography and positron emission tomography. The sigmoid colon and enlarged lymph nodes were surgically resected, and cancerous ascites were present. Pathologically, the tumor in the lymph node was a poorly-differentiated adenocarcinoma that was positive for CA19-9 as well as CK7(-/+), CK20(+/-), VEGF(+), p 53(+)and MIB-1(>10%). We treated this case as a pancreatic or bile duct carcinoma due to the patient's markedly elevated serum levels of CA19-9 and SPan-1. However, we could not make a conclusive diagnosis. Gemcitabine-based chemotherapy was administered, and the patient had no signs of recurrence for 24 months after the operation. Then, a recurrence was identified by imaging studies, and the chemotherapy was changed to paclitaxel and carboplatin. The patient had stable disease until tumor regrowth was identified 38 months after the operation, chemotherapy was then stopped. However, at 48 months after the operation, the patient remains well and has no symptoms. Our case suggests that surgery and the appropriate choice of anti-cancer drugs may contribute to the long-term survival of patients with cancer of an unknown primary origin.
要旨
症例は63歳,男性。S状結腸間膜の腫瘍に対し開腹手術を施行。癌性腹水を伴っており,姑息的にリンパ節を含むS状結腸を切除した。病理診断では低分化型腺癌であった。病理学的にも臨床的にも原発は特定できなかったが,免疫染色にてCA19-9が陽性を示したことなどを総合的に判断し,膵癌に準じた治療を行うこととした。gemcitabineをベースとした化学療法で術後24か月間無症状,無再発で経過したが,尿管剥離面より局所再発を来したため,paclitaxel+carboplatinに切り替え治療を継続した。しかし術後38か月でprogressive disease(PD)となり以後無治療にて経過観察しているが,術後48か月現在無症状にて生存中である。原発不明癌の原発巣推定,治療方針の決定に免疫組織化学的検索が極めて有用であり,予後不良群の原発不明癌に対しても腫瘍減量手術と適切な化学療法の選択にて,長期生存を得られる可能性があることを示唆する症例である。