内容紹介
Summary
We report a case of locally advanced rectal cancer presenting with perforation that was successfully resected after preoperative chemotherapy. A 66-year-old woman visited our emergency room complaining of lower abdominal pain. Abdominal CT showed a rectal tumor with fluid collection and free air in the pelvis. The patient was diagnosed with panperitonitis secondary to cancerous perforation and underwent sigmoid colostomy. A biopsy specimen of the rectal tumor showed well-differentiated tubular adenocarcinoma and wild-type RAS. After 8 courses of mFOLFOX6 plus panitumumab, the tumor shrank remarkably, and radical surgery(low anterior resection with D3 lymph node dissection)was performed. Microscopic examination of the resected specimen showed that almost half of the tumor cells were replaced by histiocytes and necrotic tissue. Preoperative chemotherapy with panitumumab may be an effective treatment for RAS wild-type locally advanced colon cancer, even if the primary tumor develops perforation.
要旨
症例は66歳,女性。下腹部痛を主訴に救急外来を受診した。CT検査で直腸に腫瘤を,骨盤内に液体貯留と遊離ガスを認めた。直腸癌穿孔と診断し,S状結腸双孔式人工肛門造設術を施行した。腫瘍の生検組織検査で高分化管状腺癌,RAS野生型と診断した。mFOLFOX6+panitumumabを8コース施行後に根治手術を行い,病理組織学的効果判定はGrade 1bであった。panitumumabを用いた術前化学療法は,穿孔性腹膜炎で発症した局所進行大腸癌に対しても有用であることが示唆された。
目次
We report a case of locally advanced rectal cancer presenting with perforation that was successfully resected after preoperative chemotherapy. A 66-year-old woman visited our emergency room complaining of lower abdominal pain. Abdominal CT showed a rectal tumor with fluid collection and free air in the pelvis. The patient was diagnosed with panperitonitis secondary to cancerous perforation and underwent sigmoid colostomy. A biopsy specimen of the rectal tumor showed well-differentiated tubular adenocarcinoma and wild-type RAS. After 8 courses of mFOLFOX6 plus panitumumab, the tumor shrank remarkably, and radical surgery(low anterior resection with D3 lymph node dissection)was performed. Microscopic examination of the resected specimen showed that almost half of the tumor cells were replaced by histiocytes and necrotic tissue. Preoperative chemotherapy with panitumumab may be an effective treatment for RAS wild-type locally advanced colon cancer, even if the primary tumor develops perforation.
要旨
症例は66歳,女性。下腹部痛を主訴に救急外来を受診した。CT検査で直腸に腫瘤を,骨盤内に液体貯留と遊離ガスを認めた。直腸癌穿孔と診断し,S状結腸双孔式人工肛門造設術を施行した。腫瘍の生検組織検査で高分化管状腺癌,RAS野生型と診断した。mFOLFOX6+panitumumabを8コース施行後に根治手術を行い,病理組織学的効果判定はGrade 1bであった。panitumumabを用いた術前化学療法は,穿孔性腹膜炎で発症した局所進行大腸癌に対しても有用であることが示唆された。