内容紹介
Summary
The patient was a 57-year-old woman. Preclinical examination of malignant lymphoma revealed 0-Ⅰsp type of early rectal cancer in the upper rectum, 20 cm from the anal margin. Endoscopic mucosal resection was performed and positive deep margins were pathologically diagnosed. Additional intestinal resection with lymph node dissection was deemed necessary, but ABVD therapy was initiated because the clinical stage of the malignant lymphoma was Stage Ⅲb or higher. Two months after detecting elevated CEA, S8 liver metastasis was pointed out, and examination of weakness of the right upper limb revealed nodular, multifocal brain metastasis. After chemotherapy for malignant lymphoma, bevacizumab(BV)plus Xelox therapy was initiated. After administering 4 courses, partial loss of multiple brain metastases and reduction of the liver metastatic lesion were confirmed; therefore, partial resection of the liver via laparoscopy was performed. After surgery, BV plus Xelox therapy was resumed, but since the lower lobular lung metastasis was confirmed after 8 courses, partial resection of the left lower lobe with thoracoscopy was performed. After lung resection, BV plus FOLFIRI therapy was administered, and 12 months after the onset of treatment for brain metastasis, recurrence was not detected.
要旨
症例は57歳,女性。悪性リンパ腫の加療前精査で肛門縁より20 cmの上部直腸に0-Ⅰsp型の早期直腸癌を認めた。内視鏡的粘膜切除術が施行され,病理診断で深部断端陽性と診断された。リンパ節郭清を伴う追加腸切除が必要と判断されたが,悪性リンパ腫の臨床病期がStage Ⅲb以上であることから生命予後を考慮しABVD療法を開始した。2か月後にCEAが上昇し,精査でS8肝転移を認め,また一過性の右上肢脱力を認めたため精査をしたところ,小結節状の多発脳転移を認めた。悪性リンパ腫の化学療法終了後,bevacizumab(BV)+Xelox療法を開始した。4コース施行後,多発脳転移の消失,肝転移巣の縮小を認めたため腹腔鏡下肝S8部分切除を施行した。術後はBV+Xelox療法を再開したが,8コース施行後に左下葉肺転移を認めたため胸腔鏡下左下葉部分切除術を施行した。肺切除後はBV+FOLFIRI療法を行い,脳転移を含め治療開始後12か月再発所見は認めていない。
目次
The patient was a 57-year-old woman. Preclinical examination of malignant lymphoma revealed 0-Ⅰsp type of early rectal cancer in the upper rectum, 20 cm from the anal margin. Endoscopic mucosal resection was performed and positive deep margins were pathologically diagnosed. Additional intestinal resection with lymph node dissection was deemed necessary, but ABVD therapy was initiated because the clinical stage of the malignant lymphoma was Stage Ⅲb or higher. Two months after detecting elevated CEA, S8 liver metastasis was pointed out, and examination of weakness of the right upper limb revealed nodular, multifocal brain metastasis. After chemotherapy for malignant lymphoma, bevacizumab(BV)plus Xelox therapy was initiated. After administering 4 courses, partial loss of multiple brain metastases and reduction of the liver metastatic lesion were confirmed; therefore, partial resection of the liver via laparoscopy was performed. After surgery, BV plus Xelox therapy was resumed, but since the lower lobular lung metastasis was confirmed after 8 courses, partial resection of the left lower lobe with thoracoscopy was performed. After lung resection, BV plus FOLFIRI therapy was administered, and 12 months after the onset of treatment for brain metastasis, recurrence was not detected.
要旨
症例は57歳,女性。悪性リンパ腫の加療前精査で肛門縁より20 cmの上部直腸に0-Ⅰsp型の早期直腸癌を認めた。内視鏡的粘膜切除術が施行され,病理診断で深部断端陽性と診断された。リンパ節郭清を伴う追加腸切除が必要と判断されたが,悪性リンパ腫の臨床病期がStage Ⅲb以上であることから生命予後を考慮しABVD療法を開始した。2か月後にCEAが上昇し,精査でS8肝転移を認め,また一過性の右上肢脱力を認めたため精査をしたところ,小結節状の多発脳転移を認めた。悪性リンパ腫の化学療法終了後,bevacizumab(BV)+Xelox療法を開始した。4コース施行後,多発脳転移の消失,肝転移巣の縮小を認めたため腹腔鏡下肝S8部分切除を施行した。術後はBV+Xelox療法を再開したが,8コース施行後に左下葉肺転移を認めたため胸腔鏡下左下葉部分切除術を施行した。肺切除後はBV+FOLFIRI療法を行い,脳転移を含め治療開始後12か月再発所見は認めていない。