内容紹介
A Case of Heterochronic Ovarian Metastasis from Sigmoid Colon Cancer after Sigmoidectomy Treated with CapeOX That Included Bevacizumab
Summary
The patient was a 41-year-old woman. When she was 39 years old, she had undergone laparoscopic high anterior resection for sigmoid colon cancer without adjuvant chemotherapy. Histologically, the surgical specimen was type 2, tub2, pT4a(SE), pN0, int, INF b, ly1, v1, and pStageⅡ. Nine months after the operation, she suffered from abdominal fullness. Laboratory data showed elevation of tumor markers: the CEA level was 6.48 ng/mL, the CA19-9 level was 89.70 U/mL, and the CA125 level was 662 U/mL. Computed tomography revealed bilateral ovarian tumors and lung and peritoneal nodules with massive ascites. Chemotherapy was started with a regimen consisting of capecitabine plus oxaliplatin(CapeOX)that included bevacizumab. After 4 courses, the sizes of the lung and peritoneal nodules had decreased and the amount of ascites was almost zero. However, the ovarian tumors had increased in size and her sense of abdominal fullness had not improved. Bilateral oophorectomy with hysterectomy was performed to alleviate her symptom. Immunohistochemically, the resected ovarian tumors were negative for cytokeratin 7 and positive for cytokeratin 20. CapeOX with bevacizumab was then resumed. However, the lung tumor had gradually increased in size, and therefore, she underwent partial resection of the lung for the metastatic lung tumor.
要旨
症例は41歳,女性。39歳時にS状結腸癌に対し腹腔鏡下高位前方切除術を施行された。病理診断はtype 2,tub2,pT4a(SE),pN0,int,INF b,ly1,v1,pStageⅡ。術後補助化学療法は希望しなかった。術後9か月目に腹部膨満感を自覚。CEA 6.48 ng/mL,CA19-9 89.70 U/mL,CA125 662 U/mLと上昇,CT検査では両側卵巣腫瘍,多量の腹水,腹膜結節,左肺の結節影を指摘され,S状結腸癌術後,両側卵巣転移,腹膜播種,肺転移と診断された。CapeOX+bevacizumab(capecitabine 2,000 mg/m2/day,day 1～14,oxaliplatin 130 mg/m2,day 1,bevacizumab 7.5 mg/kg,day 1)による化学療法を開始。4コース後,CT上腹水は著明に減少,肺転移巣も縮小したが,卵巣転移は増大し腹部膨満感は改善しなかった。QOL改善の目的で子宮+両側卵巣切除術を施行した。切除した卵巣腫瘍は高分化型腺癌で,免疫組織染色ではCK7陰性,CK20陽性であった。術後CapeOX+bevacizumabによる化学療法を再開したが,肺転移巣は増大傾向であったため肺部分切除術を施行した。
目次
Summary
The patient was a 41-year-old woman. When she was 39 years old, she had undergone laparoscopic high anterior resection for sigmoid colon cancer without adjuvant chemotherapy. Histologically, the surgical specimen was type 2, tub2, pT4a(SE), pN0, int, INF b, ly1, v1, and pStageⅡ. Nine months after the operation, she suffered from abdominal fullness. Laboratory data showed elevation of tumor markers: the CEA level was 6.48 ng/mL, the CA19-9 level was 89.70 U/mL, and the CA125 level was 662 U/mL. Computed tomography revealed bilateral ovarian tumors and lung and peritoneal nodules with massive ascites. Chemotherapy was started with a regimen consisting of capecitabine plus oxaliplatin(CapeOX)that included bevacizumab. After 4 courses, the sizes of the lung and peritoneal nodules had decreased and the amount of ascites was almost zero. However, the ovarian tumors had increased in size and her sense of abdominal fullness had not improved. Bilateral oophorectomy with hysterectomy was performed to alleviate her symptom. Immunohistochemically, the resected ovarian tumors were negative for cytokeratin 7 and positive for cytokeratin 20. CapeOX with bevacizumab was then resumed. However, the lung tumor had gradually increased in size, and therefore, she underwent partial resection of the lung for the metastatic lung tumor.
要旨
症例は41歳,女性。39歳時にS状結腸癌に対し腹腔鏡下高位前方切除術を施行された。病理診断はtype 2,tub2,pT4a(SE),pN0,int,INF b,ly1,v1,pStageⅡ。術後補助化学療法は希望しなかった。術後9か月目に腹部膨満感を自覚。CEA 6.48 ng/mL,CA19-9 89.70 U/mL,CA125 662 U/mLと上昇,CT検査では両側卵巣腫瘍,多量の腹水,腹膜結節,左肺の結節影を指摘され,S状結腸癌術後,両側卵巣転移,腹膜播種,肺転移と診断された。CapeOX+bevacizumab(capecitabine 2,000 mg/m2/day,day 1～14,oxaliplatin 130 mg/m2,day 1,bevacizumab 7.5 mg/kg,day 1)による化学療法を開始。4コース後,CT上腹水は著明に減少,肺転移巣も縮小したが,卵巣転移は増大し腹部膨満感は改善しなかった。QOL改善の目的で子宮+両側卵巣切除術を施行した。切除した卵巣腫瘍は高分化型腺癌で,免疫組織染色ではCK7陰性,CK20陽性であった。術後CapeOX+bevacizumabによる化学療法を再開したが,肺転移巣は増大傾向であったため肺部分切除術を施行した。