内容紹介
Summary
A 50-year-old woman with abdominal fullness, lower abdominal pain, elevated serum CA125, and ascites, underwent neoadjuvant chemotherapy with 6 courses of PTX/CBDCA followed by total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and intrapelvic peritoneal stripping based on a diagnosis of serous surface papillary carcinoma(SSPC) of the peritoneum. Complete response(CR)was shown after adjuvant chemotherapy with 3 courses of the same regimen. After 6 months, serum CA125 level re-increased and abdominal CT showed small low density areas in the patient's spleen and the perisplenic fat tissue. After the additional chemotherapy with 3 courses of PTX/CBDCA were performed based on a diagnosis of metastatic lesion from SSPC, anaphylactic shock occurred as the severe adverse event. The patient was given 9 more courses of the chemotherapy changed the regimen to PTX/CDDP. The splenic metastatic lesion had grown rapidly in the followed CT and then, laparoscopic splenectomy with peritoneal resection was performed based on a diagnosis of splenic metastasis from SSPC. The pathological examinations showed the tumor to be a splenic metastasis and peritoneal dissemination from SSPC. No recurrent lesion has been detected in the 9 months since removal of the splenic metastasis without adjuvant chemotherapy and the patient has survived for 4 years and 6 months since initial treatment.
要旨
症例は50歳,女性。腹部膨満感と下腹部痛を主訴に近医を受診した。血中CA125値の上昇と腹水を認め当院に紹介となった。精査の結果,腹膜原発表在性漿液性乳頭状腺癌(serous surface papillary carcinoma: SSPC)と診断され,術前化学療法(PTX/CBDCA)を施行後,初回減量手術として子宮全摘術,両側付属器切除,大網切除,骨盤内腹膜ストリッピングを施行した。術後補助化学療法が追加されCRとなったが血中CA125値の再上昇とCTにて脾臓および脾臓周囲脂肪織にLDAを認めSSPCの再発と診断した。再度化学療法(PTX/CBDCA)を施行したが,アナフィラキシーショックのためレジメンを変更(PTX/CDDP)するも脾転移病変が増大しPDとなった。脾臓周囲以外に病変を認めず,腹腔鏡下脾臓摘出術,脾臓周囲腹膜ストリッピングを施行した。病理検査にてSSPCの脾臓転移および脾臓周囲腹膜播種と診断された。術後補助化学療法は施行せず,腹腔鏡下脾臓摘出術後9か月,初回治療から4年6か月を経過した現在,無再発生存中である。
目次
A 50-year-old woman with abdominal fullness, lower abdominal pain, elevated serum CA125, and ascites, underwent neoadjuvant chemotherapy with 6 courses of PTX/CBDCA followed by total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and intrapelvic peritoneal stripping based on a diagnosis of serous surface papillary carcinoma(SSPC) of the peritoneum. Complete response(CR)was shown after adjuvant chemotherapy with 3 courses of the same regimen. After 6 months, serum CA125 level re-increased and abdominal CT showed small low density areas in the patient's spleen and the perisplenic fat tissue. After the additional chemotherapy with 3 courses of PTX/CBDCA were performed based on a diagnosis of metastatic lesion from SSPC, anaphylactic shock occurred as the severe adverse event. The patient was given 9 more courses of the chemotherapy changed the regimen to PTX/CDDP. The splenic metastatic lesion had grown rapidly in the followed CT and then, laparoscopic splenectomy with peritoneal resection was performed based on a diagnosis of splenic metastasis from SSPC. The pathological examinations showed the tumor to be a splenic metastasis and peritoneal dissemination from SSPC. No recurrent lesion has been detected in the 9 months since removal of the splenic metastasis without adjuvant chemotherapy and the patient has survived for 4 years and 6 months since initial treatment.
要旨
症例は50歳,女性。腹部膨満感と下腹部痛を主訴に近医を受診した。血中CA125値の上昇と腹水を認め当院に紹介となった。精査の結果,腹膜原発表在性漿液性乳頭状腺癌(serous surface papillary carcinoma: SSPC)と診断され,術前化学療法(PTX/CBDCA)を施行後,初回減量手術として子宮全摘術,両側付属器切除,大網切除,骨盤内腹膜ストリッピングを施行した。術後補助化学療法が追加されCRとなったが血中CA125値の再上昇とCTにて脾臓および脾臓周囲脂肪織にLDAを認めSSPCの再発と診断した。再度化学療法(PTX/CBDCA)を施行したが,アナフィラキシーショックのためレジメンを変更(PTX/CDDP)するも脾転移病変が増大しPDとなった。脾臓周囲以外に病変を認めず,腹腔鏡下脾臓摘出術,脾臓周囲腹膜ストリッピングを施行した。病理検査にてSSPCの脾臓転移および脾臓周囲腹膜播種と診断された。術後補助化学療法は施行せず,腹腔鏡下脾臓摘出術後9か月,初回治療から4年6か月を経過した現在,無再発生存中である。