内容紹介
A Case of Appendix Cancer Treated as Cancer of Unknown Primary Origin
Summary
A 57-year-old man initially presented with chief complaints of abdominal distension and anorexia. Positron emission tomography-computed tomography(PET-CT)scan showed ascites and multiple peritoneal metastases with abnormal uptake of fluorodeoxyglucose(FDG). The patient underwent endoscopy, biopsy, and cytology and was diagnosed with adenocarcinoma of unknown primary origin. He was treated with systematic chemotherapy, including carboplatin/paclitaxel(CBDCA/PTX)and gemcitabine regimens. However, progressive disease(PD)complicated by intestinal obstruction was indicated. He was referred to our department for management. We performed surgery to resolve the intestinal obstruction and confirm the diagnosis. Appendix cancer was diagnosed intraoperatively. He was administered a modified fluorouracil plus Leucovorin and oxaliplatin(mFOLFOX6)/panitumumab regimen following surgery. The tumor had a good response to treatment, and the primary lesion was resected. After resection, the tumor was controlled by systemic chemotherapy for six months. However, the patient unfortunately died owing to arrhythmia. Most patients with cancer of unknown primary origin have a very poor prognosis because it is difficult to select appropriate treatment. Laparotomy can be effective in making a definitive diagnosis, as in the case described here.
要旨 われわれは原発不明癌として治療を受けていたが増悪し,開腹手術による確定診断後にmodified FOLFOX6(mFOLFOX6)+panitumumab療法を施行し,部分寛解となり原発巣切除となった症例を経験したので報告する。症例は50歳台,男性。腹部膨満,食思不振を主訴に前医受診。腹水貯留を伴う腹膜結節を認め癌性腹膜炎と診断された。腹水細胞診の結果,消化管由来と診断される腺癌を認めたが,PET-CT検査,上下部消化管内視鏡検査にて原発巣の診断は得られなかった。原発不明癌としてCBDCA+PTX療法,GEM療法にて加療するも腹水増大し,播種結節に伴う腸管閉塞を認め,2013年1月当院を紹介された。腸閉塞解除目的で開腹手術施行。腹腔内は虫垂の壁肥厚および播種による回腸末端付近の閉塞を認めたため,回腸人工肛門造設および播種結節切除を行った。虫垂癌の診断を得て,mFOLFOX6+panitumumab療法を3コース施行し,部分寛解を得た後,再び開腹し,拡大右半結腸切除術にて原発巣および一部播種結節を切除した。現在,原発不明癌に対しては標準的治療レジメンが存在しないばかりか,化学療法によって患者の予後改善を得られるのかも明確ではない。確定診断を得るためにも可能であれば開腹手術を考慮する必要がある。
目次
Summary
A 57-year-old man initially presented with chief complaints of abdominal distension and anorexia. Positron emission tomography-computed tomography(PET-CT)scan showed ascites and multiple peritoneal metastases with abnormal uptake of fluorodeoxyglucose(FDG). The patient underwent endoscopy, biopsy, and cytology and was diagnosed with adenocarcinoma of unknown primary origin. He was treated with systematic chemotherapy, including carboplatin/paclitaxel(CBDCA/PTX)and gemcitabine regimens. However, progressive disease(PD)complicated by intestinal obstruction was indicated. He was referred to our department for management. We performed surgery to resolve the intestinal obstruction and confirm the diagnosis. Appendix cancer was diagnosed intraoperatively. He was administered a modified fluorouracil plus Leucovorin and oxaliplatin(mFOLFOX6)/panitumumab regimen following surgery. The tumor had a good response to treatment, and the primary lesion was resected. After resection, the tumor was controlled by systemic chemotherapy for six months. However, the patient unfortunately died owing to arrhythmia. Most patients with cancer of unknown primary origin have a very poor prognosis because it is difficult to select appropriate treatment. Laparotomy can be effective in making a definitive diagnosis, as in the case described here.
要旨 われわれは原発不明癌として治療を受けていたが増悪し,開腹手術による確定診断後にmodified FOLFOX6(mFOLFOX6)+panitumumab療法を施行し,部分寛解となり原発巣切除となった症例を経験したので報告する。症例は50歳台,男性。腹部膨満,食思不振を主訴に前医受診。腹水貯留を伴う腹膜結節を認め癌性腹膜炎と診断された。腹水細胞診の結果,消化管由来と診断される腺癌を認めたが,PET-CT検査,上下部消化管内視鏡検査にて原発巣の診断は得られなかった。原発不明癌としてCBDCA+PTX療法,GEM療法にて加療するも腹水増大し,播種結節に伴う腸管閉塞を認め,2013年1月当院を紹介された。腸閉塞解除目的で開腹手術施行。腹腔内は虫垂の壁肥厚および播種による回腸末端付近の閉塞を認めたため,回腸人工肛門造設および播種結節切除を行った。虫垂癌の診断を得て,mFOLFOX6+panitumumab療法を3コース施行し,部分寛解を得た後,再び開腹し,拡大右半結腸切除術にて原発巣および一部播種結節を切除した。現在,原発不明癌に対しては標準的治療レジメンが存在しないばかりか,化学療法によって患者の予後改善を得られるのかも明確ではない。確定診断を得るためにも可能であれば開腹手術を考慮する必要がある。