内容紹介
A Case of Esophageal Neuroendocrine Carcinoma for Which Irinotecan and Cisplatin Combination Therapy Was Effective
Summary
A 72-year-old previously healthy man visited our hospital with complaints of hoarseness and dysphagia. Computed tomography showed wall thickening of the thoracic esophagus; invasion to the left main bronchus, aorta, and right supraclavicular lymph nodes(LNs); right recurrent nerve LNs; and cardiac LN swelling. Esophagogastroduodenoscopy revealed an elevated tumor in the middle thoracic esophagus, which was similar to a submucosal tumor and had a longitudinal ulcer at its center. Pathologic examination showed a tumor with a high N/C ratio, and immunohistochemical staining showed the tumor was CD56 and NSE positive, with a Ki-67 index >80%. We diagnosed esophageal neuroendocrine carcinoma(NEC), cT4N3M0, Stage Ⅳa. We started chemotherapy with irinotecan and cisplatin(IP therapy)according to a regimen for small-cell lung cancer. After 3 courses of chemotherapy, the primary lesion and the LN swelling had almost disappeared. Esophageal NEC is relatively rare disease, so there are no standard established treatments. We report a case of esophageal NEC for which IP therapy was effective with the relevant literature cited.
要旨
症例は72歳,男性。2013年9月,嗄声と喉の閉塞感を主訴に当院を受診した。精査CTで胸部食道に壁肥厚と左主気管支,大動脈の圧排があり,右鎖骨上リンパ節,右反回神経リンパ節,胃噴門部リンパ節に腫大が認められた。上部消化管内視鏡検査では,胸部食道に頂部に縦走潰瘍を伴う粘膜下腫瘍様の隆起性病変が認められた。病理組織検査では,N/C比の高い腫瘍細胞の増殖,免疫組織化学染色にてCD56,NSE陽性,Ki-67の強陽性所見(>80%)が認められた。以上より,食道神経内分泌癌(NEC),cT4N3M0,Stage Ⅳaと診断し,小細胞肺癌治療に準じてイリノテカン+シスプラチン併用療法(IP療法)を施行した。3コース終了後,原発巣,リンパ節ともに完全寛解に近い縮小が得られた。食道NECは,比較的まれな食道悪性腫瘍で確立された標準治療はない。今回われわれは,IP療法が著効した食道NECの1例を経験したので文献的考察を加え報告する。
目次
Summary
A 72-year-old previously healthy man visited our hospital with complaints of hoarseness and dysphagia. Computed tomography showed wall thickening of the thoracic esophagus; invasion to the left main bronchus, aorta, and right supraclavicular lymph nodes(LNs); right recurrent nerve LNs; and cardiac LN swelling. Esophagogastroduodenoscopy revealed an elevated tumor in the middle thoracic esophagus, which was similar to a submucosal tumor and had a longitudinal ulcer at its center. Pathologic examination showed a tumor with a high N/C ratio, and immunohistochemical staining showed the tumor was CD56 and NSE positive, with a Ki-67 index >80%. We diagnosed esophageal neuroendocrine carcinoma(NEC), cT4N3M0, Stage Ⅳa. We started chemotherapy with irinotecan and cisplatin(IP therapy)according to a regimen for small-cell lung cancer. After 3 courses of chemotherapy, the primary lesion and the LN swelling had almost disappeared. Esophageal NEC is relatively rare disease, so there are no standard established treatments. We report a case of esophageal NEC for which IP therapy was effective with the relevant literature cited.
要旨
症例は72歳,男性。2013年9月,嗄声と喉の閉塞感を主訴に当院を受診した。精査CTで胸部食道に壁肥厚と左主気管支,大動脈の圧排があり,右鎖骨上リンパ節,右反回神経リンパ節,胃噴門部リンパ節に腫大が認められた。上部消化管内視鏡検査では,胸部食道に頂部に縦走潰瘍を伴う粘膜下腫瘍様の隆起性病変が認められた。病理組織検査では,N/C比の高い腫瘍細胞の増殖,免疫組織化学染色にてCD56,NSE陽性,Ki-67の強陽性所見(>80%)が認められた。以上より,食道神経内分泌癌(NEC),cT4N3M0,Stage Ⅳaと診断し,小細胞肺癌治療に準じてイリノテカン+シスプラチン併用療法(IP療法)を施行した。3コース終了後,原発巣,リンパ節ともに完全寛解に近い縮小が得られた。食道NECは,比較的まれな食道悪性腫瘍で確立された標準治療はない。今回われわれは,IP療法が著効した食道NECの1例を経験したので文献的考察を加え報告する。