内容紹介
Summary
A 71-year-old man presented with the chief complaints of constipation, melena, and weight loss, and sigmoid colon cancer was suspected on lower gastrointestinal endoscopy. The cancer was diagnosed as RAS wild type adenocarcinoma(tub2)on biopsy. Abdominal contrast-enhanced CT revealed a mass with a maximum diameter of 55 mm in the sigmoid colon; therefore, bladder infiltration was suspected. The Group 1 lymph nodes were bulky, with a maximum diameter of 50 mm, and No. 253 lymph node was enlarged. No fistulas were found on cystoscopy. The sigmoid colon cancer was cT4b(bladder), N3, M0, cStage Ⅲc. After performing a colostomy, neoadjuvant chemotherapy with mFOLFOX6 plus panitumumab was started. Radical surgery was performed after 3 courses of chemotherapy. The clinical treatment effect was PR, and the final histopathological examination revealed ypT3, ypN0(0/17), R0, ypStageⅡa. The therapeutic effect was Grade 2a. Postoperative adjuvant chemotherapy was performed for 6 months with mFOLFOX, and there have been no signs of cancer recurrence for 9 postoperative months. We experienced a case of colon cancer with suspected bladder infiltration, successfully treated with neoadjuvant chemotherapy and radical surgery.
要旨
症例は71歳,男性。便秘,黒色便,体重減少を主訴に受診した際の下部消化管内視鏡検査でS状結腸癌を指摘された。生検でadenocarcinoma(tub2),RAS wild typeと診断された。腹部造影CT検査ではS状結腸に最大横径55 mmの腫瘤を認め,膀胱浸潤が疑われた。また,bulkyな最大径50 mmの1群リンパ節およびNo. 253リンパ節の腫大を認めた。膀胱鏡では明らかな瘻孔は認められなかった。S状結腸癌,cT4b(bladder),N3,M0,cStage Ⅲcの診断となり,人工肛門造設後に術前補助化学療法としてmFOLFOX6+panitumumab療法を開始した。3コース施行後,根治手術を行った。臨床的治療効果はPR,病理組織学的最終診断はypT3,ypN0(0/17),R0,ypStageⅡa,治療効果はGrade 2aと判定された。術後補助化学療法としてmFOLFOXを6か月間施行し,現在術後9か月再発なく経過観察中である。
目次
A 71-year-old man presented with the chief complaints of constipation, melena, and weight loss, and sigmoid colon cancer was suspected on lower gastrointestinal endoscopy. The cancer was diagnosed as RAS wild type adenocarcinoma(tub2)on biopsy. Abdominal contrast-enhanced CT revealed a mass with a maximum diameter of 55 mm in the sigmoid colon; therefore, bladder infiltration was suspected. The Group 1 lymph nodes were bulky, with a maximum diameter of 50 mm, and No. 253 lymph node was enlarged. No fistulas were found on cystoscopy. The sigmoid colon cancer was cT4b(bladder), N3, M0, cStage Ⅲc. After performing a colostomy, neoadjuvant chemotherapy with mFOLFOX6 plus panitumumab was started. Radical surgery was performed after 3 courses of chemotherapy. The clinical treatment effect was PR, and the final histopathological examination revealed ypT3, ypN0(0/17), R0, ypStageⅡa. The therapeutic effect was Grade 2a. Postoperative adjuvant chemotherapy was performed for 6 months with mFOLFOX, and there have been no signs of cancer recurrence for 9 postoperative months. We experienced a case of colon cancer with suspected bladder infiltration, successfully treated with neoadjuvant chemotherapy and radical surgery.
要旨
症例は71歳,男性。便秘,黒色便,体重減少を主訴に受診した際の下部消化管内視鏡検査でS状結腸癌を指摘された。生検でadenocarcinoma(tub2),RAS wild typeと診断された。腹部造影CT検査ではS状結腸に最大横径55 mmの腫瘤を認め,膀胱浸潤が疑われた。また,bulkyな最大径50 mmの1群リンパ節およびNo. 253リンパ節の腫大を認めた。膀胱鏡では明らかな瘻孔は認められなかった。S状結腸癌,cT4b(bladder),N3,M0,cStage Ⅲcの診断となり,人工肛門造設後に術前補助化学療法としてmFOLFOX6+panitumumab療法を開始した。3コース施行後,根治手術を行った。臨床的治療効果はPR,病理組織学的最終診断はypT3,ypN0(0/17),R0,ypStageⅡa,治療効果はGrade 2aと判定された。術後補助化学療法としてmFOLFOXを6か月間施行し,現在術後9か月再発なく経過観察中である。