内容紹介
A Case of Myocardial Metastasis of Esophageal Squamous Cell Carcinoma
Summary
Myocardial metastasis for esophageal squamous cell carcinoma(ESCC)is relatively rare and it is diagnosed as a part of widespread metastasis in the terminal stage. We experienced a case of myocardial metastasis of ESCC treated effectively with chemoradiotherapy. A 56-year-old man was diagnosed ESCC(clinical T3N2M0, StageⅢ). He received neoadjuvant chemotherapy of 5-fluorouracil plus cisplatin followed by subtotal esophagectomy with dissection of the 3 regional lymph nodes. The pathological diagnosis was moderate differentiated squamous cell carcinoma, CT-pT3(T3), pN1, sM0, fStageⅢ. Four months after surgery, he had no clinical symptom, however myocardial metastasis located in the apex was detected on the follow up positron emission tomography(PET). Chemoradiotherapy was performed for the myocardial metastasis. Myocardial metastasis treated effectively with chemoradiotherapy almost disappeared on the PET and computed tomography taken 3 months after chemoradiotherapy. He died, however, of multiple liver and bone metastases 15 months after the initial surgery.
要旨
症例は56歳,男性。つかえ感を主訴に近医を受診し,上部消化管内視鏡検査にて切歯より25 cmに全周性の2型腫瘍(扁平上皮癌)を認め,加療目的に当科紹介となった。cT3N2M0,cStageⅢであり,術前補助化学療法としてFP療法を2コース施行後に右開胸開腹食道亜全摘術,3領域リンパ節郭清,胸骨後経路胃管再建術を施行した。病理結果は中分化型扁平上皮癌,CT-pT3(T3),pN1,sM0,fStageⅢであった。術後4か月時のPET-CTにて心尖部に局所的な陽性集積を認め,転移性心筋腫瘍と診断し,放射線化学療法(CRT)(心筋50 Gy,FP療法2コース)を施行した。CRT後3か月後のPET-CTでは心臓の腫瘤像およびFDG集積は消失し,CRと判断した。その後は骨転移,肝転移の出現を認め集学的治療を施行したが,食道癌術後15か月,心筋転移診断後11か月で死亡した。食道癌の心筋転移は非常にまれであり予後不良とされるが,本症例は集学的治療により心筋転移診断後約1年の長期生存が得られた1例であり,これを報告する。
目次
Summary
Myocardial metastasis for esophageal squamous cell carcinoma(ESCC)is relatively rare and it is diagnosed as a part of widespread metastasis in the terminal stage. We experienced a case of myocardial metastasis of ESCC treated effectively with chemoradiotherapy. A 56-year-old man was diagnosed ESCC(clinical T3N2M0, StageⅢ). He received neoadjuvant chemotherapy of 5-fluorouracil plus cisplatin followed by subtotal esophagectomy with dissection of the 3 regional lymph nodes. The pathological diagnosis was moderate differentiated squamous cell carcinoma, CT-pT3(T3), pN1, sM0, fStageⅢ. Four months after surgery, he had no clinical symptom, however myocardial metastasis located in the apex was detected on the follow up positron emission tomography(PET). Chemoradiotherapy was performed for the myocardial metastasis. Myocardial metastasis treated effectively with chemoradiotherapy almost disappeared on the PET and computed tomography taken 3 months after chemoradiotherapy. He died, however, of multiple liver and bone metastases 15 months after the initial surgery.
要旨
症例は56歳,男性。つかえ感を主訴に近医を受診し,上部消化管内視鏡検査にて切歯より25 cmに全周性の2型腫瘍(扁平上皮癌)を認め,加療目的に当科紹介となった。cT3N2M0,cStageⅢであり,術前補助化学療法としてFP療法を2コース施行後に右開胸開腹食道亜全摘術,3領域リンパ節郭清,胸骨後経路胃管再建術を施行した。病理結果は中分化型扁平上皮癌,CT-pT3(T3),pN1,sM0,fStageⅢであった。術後4か月時のPET-CTにて心尖部に局所的な陽性集積を認め,転移性心筋腫瘍と診断し,放射線化学療法(CRT)(心筋50 Gy,FP療法2コース)を施行した。CRT後3か月後のPET-CTでは心臓の腫瘤像およびFDG集積は消失し,CRと判断した。その後は骨転移,肝転移の出現を認め集学的治療を施行したが,食道癌術後15か月,心筋転移診断後11か月で死亡した。食道癌の心筋転移は非常にまれであり予後不良とされるが,本症例は集学的治療により心筋転移診断後約1年の長期生存が得られた1例であり,これを報告する。