内容紹介
Summary
The present case pertained to a 70-year-old woman. The fecal occult blood test was positive. Colonoscopy revealed rectal cancer. She underwent the first operation of low anterior resection. Pathological diagnosis was carcinoid, se, ly2, v0, n1. Approximately 2 months later, multiple liver metastases were found. Because of strong enhancement at angiography, transarterial chemoembolization(TACE)was selected. After 3 rounds of TACE, we operated the residual liver metastasis approximately 1 year and 7 months after the first operation. However, approximately 8 years and 9 months after the first operation, multiple liver metastases were found again. Hepatic arterial infusion(HAI)was chosen because tumors showed weak enhancement on CT. First, we tried high-dose HAI(5-FU 1 g/day at 1-3 and 5-7, amount: 6 g/week), and liver metastases was almost in CR. However, extrahepatic metastasis was found on PET-CT. Because of rapid growth, we operated the growing lymph node. Pathological diagnosis was diffuse large-cell type B-cell malignant lymphoma. Thus, we extended the interval of HAI(weekly, biweekly, and monthly)and simultaneously 4 courses of R-THP-COP(R: rituximab, THP: pirarubicin, C: cyclophosphamide, O: vincristine, P: prednisolone)therapy for malignant lymphoma was administered. She is now an outpatient. Liver metastases continue to be in CR at approximately 1 year and the IL-2R value is almost within normal range.
要旨
症例は70歳,女性。主訴は便潜血陽性。精査の上,直腸癌と診断した。低位前方切除術ならびにD3郭清を施行した。carcinoid,se,ly2,v0,n1であった。約2か月後,多発肝転移と診断した。肝動脈化学塞栓療法(TACE)を計3回施行し,残存する肝転移を約1年7か月目に切除した。その後,初回手術から約8年9か月目に再び多発肝転移を起こし,短期大量肝動注療法(day 1～3,5～7に5-FU 1 g/day持続動注)を施行した。1回の治療でCRに近いPRとなった。しかしその後のPET-CT検査にて肝外転移が指摘された。急激に増大したためリンパ節再発として開腹摘出した。病理組織学的結果は,びまん性大細胞型B細胞リンパ腫であった。現在,肝動注療法とR-THP-COP療法の併用によりIL-2Rも正常化し,肝転移も1年間CRを保っている。
目次
The present case pertained to a 70-year-old woman. The fecal occult blood test was positive. Colonoscopy revealed rectal cancer. She underwent the first operation of low anterior resection. Pathological diagnosis was carcinoid, se, ly2, v0, n1. Approximately 2 months later, multiple liver metastases were found. Because of strong enhancement at angiography, transarterial chemoembolization(TACE)was selected. After 3 rounds of TACE, we operated the residual liver metastasis approximately 1 year and 7 months after the first operation. However, approximately 8 years and 9 months after the first operation, multiple liver metastases were found again. Hepatic arterial infusion(HAI)was chosen because tumors showed weak enhancement on CT. First, we tried high-dose HAI(5-FU 1 g/day at 1-3 and 5-7, amount: 6 g/week), and liver metastases was almost in CR. However, extrahepatic metastasis was found on PET-CT. Because of rapid growth, we operated the growing lymph node. Pathological diagnosis was diffuse large-cell type B-cell malignant lymphoma. Thus, we extended the interval of HAI(weekly, biweekly, and monthly)and simultaneously 4 courses of R-THP-COP(R: rituximab, THP: pirarubicin, C: cyclophosphamide, O: vincristine, P: prednisolone)therapy for malignant lymphoma was administered. She is now an outpatient. Liver metastases continue to be in CR at approximately 1 year and the IL-2R value is almost within normal range.
要旨
症例は70歳,女性。主訴は便潜血陽性。精査の上,直腸癌と診断した。低位前方切除術ならびにD3郭清を施行した。carcinoid,se,ly2,v0,n1であった。約2か月後,多発肝転移と診断した。肝動脈化学塞栓療法(TACE)を計3回施行し,残存する肝転移を約1年7か月目に切除した。その後,初回手術から約8年9か月目に再び多発肝転移を起こし,短期大量肝動注療法(day 1～3,5～7に5-FU 1 g/day持続動注)を施行した。1回の治療でCRに近いPRとなった。しかしその後のPET-CT検査にて肝外転移が指摘された。急激に増大したためリンパ節再発として開腹摘出した。病理組織学的結果は,びまん性大細胞型B細胞リンパ腫であった。現在,肝動注療法とR-THP-COP療法の併用によりIL-2Rも正常化し,肝転移も1年間CRを保っている。