内容紹介
Summary
A 47-year-old woman presented with a hard umbilical nodule that appeared red and was painful. A biopsy of the umbilical nodule revealed adenocarcinoma. As a result of general examinations, the patient was diagnosed with umbilical, hepatic, and ovarian metastases from transverse colon cancer. She was treated with S-1 and oxaliplatin(SOX)plus bevacizumab chemotherapy. After 4 courses of chemotherapy, CT revealed that the primary lesion and umbilical and hepatic metastases had reduced in size. We considered this to be a partial response and thus administered 4 additional courses of SOX plus bevacizumab chemotherapy. Finally, she remained well for 22 months and achieved relatively good prognosis. An umbilical metastasis from an internal malignancy is known as a Sister Mary Joseph's nodule, and it has very poor prognosis. Most studies show that the survival period from the time of diagnosis is within 1 year. However, our case suggests that novel anti-cancer drugs or molecular-targeted agents may improve survival.
要旨
臍部に結節性病変を形成した内臓悪性腫瘍の臍転移は,Sister Mary Joseph's noduleと呼ばれている。今回われわれは,臍腫瘤を契機に発見された横行結腸癌に対してS-1+oxaliplatin(SOX)+bevacizumab療法が著効し長期生存を得た1例を経験したので報告する。症例は47歳,女性。臍腫瘤を主訴に当院皮膚科を受診し生検にて腺癌が検出され,悪性腫瘍の臍転移が疑われたため当科に紹介された。精査にて横行結腸癌の臍転移,皮膚転移,肝転移,卵巣転移と診断し,SOX+bevacizumab療法を開始した。4コース目で著効し,原発巣および肝転移巣,臍転移,皮膚転移は著明に縮小した。その後さらにSOX+bevacizumab療法を4コース継続したが卵巣転移が増大傾向にあったため,初回治療から8か月後に右付属器切除術,回腸双孔式人工肛門造設術,皮膚転移摘出術を施行した。術後はsecond-line化学療法を継続したが,初診時から22か月後に癌死した。臍転移は発見から死亡まで1年以内との報告も多く予後不良の兆候とされているが,新規抗癌剤や分子標的薬の使用により生存期間の延長が期待できる。
目次
A 47-year-old woman presented with a hard umbilical nodule that appeared red and was painful. A biopsy of the umbilical nodule revealed adenocarcinoma. As a result of general examinations, the patient was diagnosed with umbilical, hepatic, and ovarian metastases from transverse colon cancer. She was treated with S-1 and oxaliplatin(SOX)plus bevacizumab chemotherapy. After 4 courses of chemotherapy, CT revealed that the primary lesion and umbilical and hepatic metastases had reduced in size. We considered this to be a partial response and thus administered 4 additional courses of SOX plus bevacizumab chemotherapy. Finally, she remained well for 22 months and achieved relatively good prognosis. An umbilical metastasis from an internal malignancy is known as a Sister Mary Joseph's nodule, and it has very poor prognosis. Most studies show that the survival period from the time of diagnosis is within 1 year. However, our case suggests that novel anti-cancer drugs or molecular-targeted agents may improve survival.
要旨
臍部に結節性病変を形成した内臓悪性腫瘍の臍転移は,Sister Mary Joseph's noduleと呼ばれている。今回われわれは,臍腫瘤を契機に発見された横行結腸癌に対してS-1+oxaliplatin(SOX)+bevacizumab療法が著効し長期生存を得た1例を経験したので報告する。症例は47歳,女性。臍腫瘤を主訴に当院皮膚科を受診し生検にて腺癌が検出され,悪性腫瘍の臍転移が疑われたため当科に紹介された。精査にて横行結腸癌の臍転移,皮膚転移,肝転移,卵巣転移と診断し,SOX+bevacizumab療法を開始した。4コース目で著効し,原発巣および肝転移巣,臍転移,皮膚転移は著明に縮小した。その後さらにSOX+bevacizumab療法を4コース継続したが卵巣転移が増大傾向にあったため,初回治療から8か月後に右付属器切除術,回腸双孔式人工肛門造設術,皮膚転移摘出術を施行した。術後はsecond-line化学療法を継続したが,初診時から22か月後に癌死した。臍転移は発見から死亡まで1年以内との報告も多く予後不良の兆候とされているが,新規抗癌剤や分子標的薬の使用により生存期間の延長が期待できる。