内容紹介
A Recurrent Case of Thymic Adenocarcinoma Effectively Treated with S-1 Over a Long-Term Period
Summary
A 61-year-old woman with an abnormal radiograph shadow in her anterior mediastinum was admitted to our hospital and underwent an extended thymectomy. The pathological diagnosis of the tumor was a non-papillary adenocarcinoma of the thymus in pathological stage Ⅳb using the Masaoka classification owing to mediastinal lymph node metastasis. We found parasternal lymph node metastases 5 months after her first operation, and subsequently, she underwent surgery and adjuvant radiotherapy. We found systemic lymph node metastases and metastatic lesions in distant organs, including her lungs, brain, and kidney 27 months after her first operation. Systemic chemotherapy, such as carboplatin plus paclitaxel and an ADOC regimen were not very effective, so we performed immunohistochemical staining of the primary thymic adenocarcinoma. The levels of both thymidylate synthase and dihydropyrimidine dehydrogenase were low; therefore, we started S-1 100 mg/body(2 weeks of administration, 1 week of withdrawal)31 months after her first operation. She entered complete remission 6 months after the initiation of S-1. We surgically resected her solitary lung metastasis 13 months after initiation of S-1, and then continued the S-1 treatment. There was no recurrence for more than 2 years after the lung surgery. We believe that when the expression levels of thymidylate synthase or dihydropyrimidine dehydrogenase are low in cases of recurrent thymic adenocarcinoma, S-1 may be able to induce an effective response.
要旨
症例は61歳,女性。前縦隔腫瘍にて当科へ紹介となり,胸腺全摘術を施行した。病理検査では縦隔リンパ節転移を伴う正岡分類Ⅳb期の胸腺癌(非乳頭状腺癌)と診断された。初回手術から5か月後に縦隔リンパ節転移が出現したため切除した後,補助放射線治療を施行した。初回手術から27か月後に全身のリンパ節転移や肺,脳,腎などの遠隔転移が出現したため,carboplatin+paclitaxelやADOC療法を相次いで施行したものの著効しなかった。腫瘍における免疫組織学的検査を行い,thymidylate synthase(TS)やdihydropyrimidine dehydrogenase(DPD)が低発現であったため,初回手術から31か月後にS-1 100 mg/bodyを2週間投与1週間休薬にて開始した。S-1は奏効し導入から6か月後に完全奏効となったが,13か月後に単発の肺転移を切除し,その後もS-1を継続した。最後の肺切除から2年経過した現在,明らかな再発病変は認めていない。TSやDPDが低発現の再発性胸腺癌に対してはS-1が著効する可能性があると考える。
目次
Summary
A 61-year-old woman with an abnormal radiograph shadow in her anterior mediastinum was admitted to our hospital and underwent an extended thymectomy. The pathological diagnosis of the tumor was a non-papillary adenocarcinoma of the thymus in pathological stage Ⅳb using the Masaoka classification owing to mediastinal lymph node metastasis. We found parasternal lymph node metastases 5 months after her first operation, and subsequently, she underwent surgery and adjuvant radiotherapy. We found systemic lymph node metastases and metastatic lesions in distant organs, including her lungs, brain, and kidney 27 months after her first operation. Systemic chemotherapy, such as carboplatin plus paclitaxel and an ADOC regimen were not very effective, so we performed immunohistochemical staining of the primary thymic adenocarcinoma. The levels of both thymidylate synthase and dihydropyrimidine dehydrogenase were low; therefore, we started S-1 100 mg/body(2 weeks of administration, 1 week of withdrawal)31 months after her first operation. She entered complete remission 6 months after the initiation of S-1. We surgically resected her solitary lung metastasis 13 months after initiation of S-1, and then continued the S-1 treatment. There was no recurrence for more than 2 years after the lung surgery. We believe that when the expression levels of thymidylate synthase or dihydropyrimidine dehydrogenase are low in cases of recurrent thymic adenocarcinoma, S-1 may be able to induce an effective response.
要旨
症例は61歳,女性。前縦隔腫瘍にて当科へ紹介となり,胸腺全摘術を施行した。病理検査では縦隔リンパ節転移を伴う正岡分類Ⅳb期の胸腺癌(非乳頭状腺癌)と診断された。初回手術から5か月後に縦隔リンパ節転移が出現したため切除した後,補助放射線治療を施行した。初回手術から27か月後に全身のリンパ節転移や肺,脳,腎などの遠隔転移が出現したため,carboplatin+paclitaxelやADOC療法を相次いで施行したものの著効しなかった。腫瘍における免疫組織学的検査を行い,thymidylate synthase(TS)やdihydropyrimidine dehydrogenase(DPD)が低発現であったため,初回手術から31か月後にS-1 100 mg/bodyを2週間投与1週間休薬にて開始した。S-1は奏効し導入から6か月後に完全奏効となったが,13か月後に単発の肺転移を切除し,その後もS-1を継続した。最後の肺切除から2年経過した現在,明らかな再発病変は認めていない。TSやDPDが低発現の再発性胸腺癌に対してはS-1が著効する可能性があると考える。