内容紹介
Summary
A 67-year-old man presented with abdominal distention and vomiting. Computed tomography revealed bowel obstruction due to a cecal tumor. We performed laparoscopic ileocecal resection after decompression with an ileus tube. Intraoperative findings included multiple disseminated nodules on the mesenterium surrounding the cecal tumor. The histopathologic diagnosis was poorly differentiated adenocarcinoma, which consisted of glandular proliferation of atypical epithelial cells and dispersed infiltration of goblet cells. Immunohistochemistry showed positively stained neuroendocrine markers, such as CD56, chromogranin, and synaptophysin. The patient was diagnosed with goblet cell carcinoid of the appendix and treated with combination chemotherapy of bevacizumab, fluorouracil, folinic acid, and oxaliplatin. He remained free from progression for over 1 and half years with this treatment. Subsequent chemotherapy was ineffective, and he passed away. There is no established chemotherapy regimen for goblet cell carcinoid, which has the aspects of both adenocarcinoma and neuroendocrine tumors. However, the present case suggested the efficacy of the mFOLFOX6 regimen in combination with bevacizumab for appendiceal goblet cell carcinoid.
要旨
症例は67歳,男性。腹部膨満感と嘔吐を主訴に当院を受診した。画像検査の結果,盲腸腫瘍に伴う腫瘍性腸閉塞と診断した。腸管減圧後,腹腔鏡下回盲部切除術を行った。術中所見として,盲腸腫瘍と回腸末端から小腸間膜にかけて複数の播種結節を認めた。病理組織学的検査では,虫垂から盲腸にかけて異型上皮細胞が索状構造を形成しながら増殖し,印環細胞の集簇も散在性にみられ,低分化な上皮系悪性腫瘍の像を呈していた。免疫染色で神経内分泌マーカーが陽性であり,杯細胞カルチノイドと診断した。bevacizumab+mFOLFOX6療法を開始し1年8か月間の病勢制御が得られた。虫垂杯細胞カルチノイドに対する標準的な化学療法は確立していないが,大腸癌に準じた本レジメンが有効な可能性が示唆された。
目次
A 67-year-old man presented with abdominal distention and vomiting. Computed tomography revealed bowel obstruction due to a cecal tumor. We performed laparoscopic ileocecal resection after decompression with an ileus tube. Intraoperative findings included multiple disseminated nodules on the mesenterium surrounding the cecal tumor. The histopathologic diagnosis was poorly differentiated adenocarcinoma, which consisted of glandular proliferation of atypical epithelial cells and dispersed infiltration of goblet cells. Immunohistochemistry showed positively stained neuroendocrine markers, such as CD56, chromogranin, and synaptophysin. The patient was diagnosed with goblet cell carcinoid of the appendix and treated with combination chemotherapy of bevacizumab, fluorouracil, folinic acid, and oxaliplatin. He remained free from progression for over 1 and half years with this treatment. Subsequent chemotherapy was ineffective, and he passed away. There is no established chemotherapy regimen for goblet cell carcinoid, which has the aspects of both adenocarcinoma and neuroendocrine tumors. However, the present case suggested the efficacy of the mFOLFOX6 regimen in combination with bevacizumab for appendiceal goblet cell carcinoid.
要旨
症例は67歳,男性。腹部膨満感と嘔吐を主訴に当院を受診した。画像検査の結果,盲腸腫瘍に伴う腫瘍性腸閉塞と診断した。腸管減圧後,腹腔鏡下回盲部切除術を行った。術中所見として,盲腸腫瘍と回腸末端から小腸間膜にかけて複数の播種結節を認めた。病理組織学的検査では,虫垂から盲腸にかけて異型上皮細胞が索状構造を形成しながら増殖し,印環細胞の集簇も散在性にみられ,低分化な上皮系悪性腫瘍の像を呈していた。免疫染色で神経内分泌マーカーが陽性であり,杯細胞カルチノイドと診断した。bevacizumab+mFOLFOX6療法を開始し1年8か月間の病勢制御が得られた。虫垂杯細胞カルチノイドに対する標準的な化学療法は確立していないが,大腸癌に準じた本レジメンが有効な可能性が示唆された。