内容紹介
Experience of the Pharmacotherapy against Appendix and Sigmoid Colon Signet Ring Cell Carcinoma with the Peritoneal Dissemination
Summary
We report 2 cases of signet ring cell carcinoma of the appendix and colon. Case 1: A 61-year-old man was admitted for lower abdominal pain. Colonoscopy revealed an elevated lesion in the orifice of the appendix. Signet ring cell carcinoma was diagnosed on biopsy. The surgical findings showed multiple peritoneal dissemination nodules, while the primary tumor was unresectable owing to extensive invasion into the retroperitoneum. The histopathological findings were signet ring cell carcinoma, T4b(retroperitoneum), NX, P3, StageⅣ. Although the patient received 14 courses of treatment with S-1 as postoperative chemotherapy, he died of his illness at 32 postoperative months. Case 2: A 76-year-old man was admitted for abdominal pain. Perforation of the lower gastrointestinal tract was diagnosed on abdominal CT, and an emergency operation was performed. The surgical findings demonstrated a large number of peritoneal dissemination nodules, cecal invasion of a sigmoid tumor, and perforation of the ascending colon. The primary tumor was thought to be unresectable, and the perforated segment was resected. The histopathological findings were signet ring cell carcinoma, T4b(cecum), NX, P3, StageⅣ. Although 11 courses of treatment using FOLFIRI+Bev were administered as postoperative chemotherapy, the patient died of his illness at 26 postoperative months.
要旨
症例1は61歳,男性。下腹部痛を主訴とした精査で虫垂印環細胞癌を認めた。手術所見では,腹膜播種結節を多数認め,原発巣は後腹膜への高度浸潤により非切除となった。T4b(後腹膜),NX,P3,StageⅣの診断で術後S-1療法を中心とした化学療法を施行し,術後32か月目で原病死となった。症例2は76歳,男性。腹痛を主訴に腹部CT検査を施行したところ,遊離ガス像を認めた。消化管穿孔,汎発性腹膜炎の診断で手術を施行。多数の腹膜播種および盲腸に浸潤するS状結腸腫瘍を認め,上行結腸に穿孔部を認めた。全身状態不良のため原発巣は非切除とし,穿孔部を含む右結腸部分切除術を施行した。T4b(盲腸),NX,P3,StageⅣの診断で術後FOLFIRI+bevacizumab療法を中心とした化学療法を施行し,術後26か月目で原病死した。いずれも多発腹膜播種を伴う切除不能の印環細胞癌症例であったが,化学療法により比較的良好な生存期間を得ることが可能であった。
目次
Summary
We report 2 cases of signet ring cell carcinoma of the appendix and colon. Case 1: A 61-year-old man was admitted for lower abdominal pain. Colonoscopy revealed an elevated lesion in the orifice of the appendix. Signet ring cell carcinoma was diagnosed on biopsy. The surgical findings showed multiple peritoneal dissemination nodules, while the primary tumor was unresectable owing to extensive invasion into the retroperitoneum. The histopathological findings were signet ring cell carcinoma, T4b(retroperitoneum), NX, P3, StageⅣ. Although the patient received 14 courses of treatment with S-1 as postoperative chemotherapy, he died of his illness at 32 postoperative months. Case 2: A 76-year-old man was admitted for abdominal pain. Perforation of the lower gastrointestinal tract was diagnosed on abdominal CT, and an emergency operation was performed. The surgical findings demonstrated a large number of peritoneal dissemination nodules, cecal invasion of a sigmoid tumor, and perforation of the ascending colon. The primary tumor was thought to be unresectable, and the perforated segment was resected. The histopathological findings were signet ring cell carcinoma, T4b(cecum), NX, P3, StageⅣ. Although 11 courses of treatment using FOLFIRI+Bev were administered as postoperative chemotherapy, the patient died of his illness at 26 postoperative months.
要旨
症例1は61歳,男性。下腹部痛を主訴とした精査で虫垂印環細胞癌を認めた。手術所見では,腹膜播種結節を多数認め,原発巣は後腹膜への高度浸潤により非切除となった。T4b(後腹膜),NX,P3,StageⅣの診断で術後S-1療法を中心とした化学療法を施行し,術後32か月目で原病死となった。症例2は76歳,男性。腹痛を主訴に腹部CT検査を施行したところ,遊離ガス像を認めた。消化管穿孔,汎発性腹膜炎の診断で手術を施行。多数の腹膜播種および盲腸に浸潤するS状結腸腫瘍を認め,上行結腸に穿孔部を認めた。全身状態不良のため原発巣は非切除とし,穿孔部を含む右結腸部分切除術を施行した。T4b(盲腸),NX,P3,StageⅣの診断で術後FOLFIRI+bevacizumab療法を中心とした化学療法を施行し,術後26か月目で原病死した。いずれも多発腹膜播種を伴う切除不能の印環細胞癌症例であったが,化学療法により比較的良好な生存期間を得ることが可能であった。