内容紹介
Summary
The patient was a 68-year-old man who had an anal fistula for>10 years. He was referred to our institution after visiting a local physician with left femoral pain as the main complaint and received a diagnosis of high inflammatory response. We then found discharge of pus in the perianal region during a medical examination. We also found an extensive intrapelvic tumor during a computed tomography(CT)/magnetic resonance imaging examination. In addition, the level of a tumor marker and inflammatory response were high. To control the inflammation, we performed seton drainage and sigmoid colostomy. On the basis of the pathological findings from the mucus component, we confirmed a diagnosis of fistula cancer. Considering that the progressive lesion had extensively spread, we decided to initiate chemotherapy alone because of the absence of an indication for radiotherapy. We administered bevacizumab plus mFOLFOX6, and partial response was observed on a CT scan. We could control the progression of the disease for>6 months. The present case suggests that bevacizumab plus mFOLFOX6 can be an effective regimen for unresectable advanced fistula cancers.
要旨
症例は68歳,男性。10年以上前から痔瘻を指摘されていた。左大腿部痛を主訴に近医を受診し,炎症反応の高値を指摘され当院を紹介された。診察にて痔瘻を認め,画像検査にて骨盤内に広範な液体貯留を伴っており,腫瘍マーカーと炎症反応も高値を認めた。炎症の制御を目的としてseton法と,膿瘍に対してドレーン留置ならびにS状結腸人工肛門造設術を施行した。粘液成分の病理結果より痔瘻癌の診断となった。病巣の進展範囲が広範なため放射線療法の適応はなく,bevacizumab+mFOLFOX6療法を行った。部分奏効を認め,6か月以上の病勢コントロールが可能であった。bevacizumab+mFOLFOX6療法は切除不能進行痔瘻癌に対する有効なregimenである可能性が示唆された。
目次
The patient was a 68-year-old man who had an anal fistula for>10 years. He was referred to our institution after visiting a local physician with left femoral pain as the main complaint and received a diagnosis of high inflammatory response. We then found discharge of pus in the perianal region during a medical examination. We also found an extensive intrapelvic tumor during a computed tomography(CT)/magnetic resonance imaging examination. In addition, the level of a tumor marker and inflammatory response were high. To control the inflammation, we performed seton drainage and sigmoid colostomy. On the basis of the pathological findings from the mucus component, we confirmed a diagnosis of fistula cancer. Considering that the progressive lesion had extensively spread, we decided to initiate chemotherapy alone because of the absence of an indication for radiotherapy. We administered bevacizumab plus mFOLFOX6, and partial response was observed on a CT scan. We could control the progression of the disease for>6 months. The present case suggests that bevacizumab plus mFOLFOX6 can be an effective regimen for unresectable advanced fistula cancers.
要旨
症例は68歳,男性。10年以上前から痔瘻を指摘されていた。左大腿部痛を主訴に近医を受診し,炎症反応の高値を指摘され当院を紹介された。診察にて痔瘻を認め,画像検査にて骨盤内に広範な液体貯留を伴っており,腫瘍マーカーと炎症反応も高値を認めた。炎症の制御を目的としてseton法と,膿瘍に対してドレーン留置ならびにS状結腸人工肛門造設術を施行した。粘液成分の病理結果より痔瘻癌の診断となった。病巣の進展範囲が広範なため放射線療法の適応はなく,bevacizumab+mFOLFOX6療法を行った。部分奏効を認め,6か月以上の病勢コントロールが可能であった。bevacizumab+mFOLFOX6療法は切除不能進行痔瘻癌に対する有効なregimenである可能性が示唆された。