内容紹介
Summary
A 78—year—old man was admitted to our hospital with a diagnosis of esophageal cancer and gastric cancer. Gastroscopy showed a type 2 tumor located in the cardia from the lower esophagus, and a pathological examination showed malignant melanoma. Based on the physical examination and other imaging tests, the patient was diagnosed with primary amelanotic malignant melanoma of the esophagus, but the tumor was unresectable due to extensive lymph node metastasis. According to the guideline, immune checkpoint inhibitor(nivolumab)was used for treatment, but because the tumor progressed after 2 courses and the performance status of the patient worsened, aggressive treatment was ended. Six weeks after finishing treatment, computed tomography showed that the tumor had shrunk to some extent. The patient ultimately died from aspiration pneumonia 4 months after the first consultation. The patient was thought to have had an immune—related adverse event, with the tumor showing pseudoprogression.
要旨
症例は78歳,男性。流涎・嘔吐・体重減少から食道癌・胃癌の診断となり紹介された。食道から胃噴門直下にかけて2型腫瘍を認め,内視鏡像・病理所見・全身検索の結果から食道原発の無色素性悪性黒色腫と診断した。広範なリンパ節転移により切除不能と考えnivolumab単剤での治療を開始したが,2コース後の評価でprogressive diseaseと判断し,全身状態の悪化も含めbest supportive careの方針とした。緩和目的のステロイドで全身状態は安定し,治療終了後6週時点で若干の腫瘍縮小を認めた。経過からnivolumabによるimmune—related adverse event(irAE)およびpseudoprogressionの病態をみていたものと判断した。積極的治療の再開は難しく他院へ転院し,誤嚥性肺炎のため死亡した。食道悪性黒色腫はまれな疾患であり,免疫チェックポイント阻害剤治療に関する報告は乏しい。治療の適応・継続判断に苦慮した症例を経験したので報告する。
目次
A 78—year—old man was admitted to our hospital with a diagnosis of esophageal cancer and gastric cancer. Gastroscopy showed a type 2 tumor located in the cardia from the lower esophagus, and a pathological examination showed malignant melanoma. Based on the physical examination and other imaging tests, the patient was diagnosed with primary amelanotic malignant melanoma of the esophagus, but the tumor was unresectable due to extensive lymph node metastasis. According to the guideline, immune checkpoint inhibitor(nivolumab)was used for treatment, but because the tumor progressed after 2 courses and the performance status of the patient worsened, aggressive treatment was ended. Six weeks after finishing treatment, computed tomography showed that the tumor had shrunk to some extent. The patient ultimately died from aspiration pneumonia 4 months after the first consultation. The patient was thought to have had an immune—related adverse event, with the tumor showing pseudoprogression.
要旨
症例は78歳,男性。流涎・嘔吐・体重減少から食道癌・胃癌の診断となり紹介された。食道から胃噴門直下にかけて2型腫瘍を認め,内視鏡像・病理所見・全身検索の結果から食道原発の無色素性悪性黒色腫と診断した。広範なリンパ節転移により切除不能と考えnivolumab単剤での治療を開始したが,2コース後の評価でprogressive diseaseと判断し,全身状態の悪化も含めbest supportive careの方針とした。緩和目的のステロイドで全身状態は安定し,治療終了後6週時点で若干の腫瘍縮小を認めた。経過からnivolumabによるimmune—related adverse event(irAE)およびpseudoprogressionの病態をみていたものと判断した。積極的治療の再開は難しく他院へ転院し,誤嚥性肺炎のため死亡した。食道悪性黒色腫はまれな疾患であり,免疫チェックポイント阻害剤治療に関する報告は乏しい。治療の適応・継続判断に苦慮した症例を経験したので報告する。