内容紹介
Summary
A 70—year—old man presented to our hospital with weight loss. A colonoscopy revealed advanced cancer in the lower rectum. Computed tomography showed a tumor larger than 5 cm in the lower rectum with metastasis to the right lateral lymph node. The patient was diagnosed with advanced locally rectal cancer, and chemoradiotherapy(35 Gy plus S—1)was added after 6 courses of mFOLFOX6, and laparoscopic abdominal perineal resection and right lateral lymph nodes dissection were performed. Histopathological examination revealed endocrine cell carcinoma(pT3[A], pN0, M0, pStage Ⅱa). Four months after the operation, recurrence was found in the pelvis, lymph nodes, and lungs, and he died 9 months after the operation. Neuroendocrine carcinoma is relatively rare, so the further accumulation of cases and establishment of treatment methods are desired.
要旨
症例は70歳,男性。体重減少を主訴に受診し,下部消化管内視鏡検査で下部直腸に3/4周性の2型病変を認め,生検では高分化管状腺癌であった。CTでは下部直腸に5 cm超の腫瘍を認め,右側方リンパ節転移を伴っていた。高度局所進行直腸癌と診断し,術前化学療法としてmFOLFOX6療法を6コース後に化学放射線療法(35 Gy+S—1)を追加し,腹腔鏡下腹会陰直腸切断術,右側方リンパ節郭清を施行した。病理組織学的検査において内分泌細胞癌[pT3(A),pN0,M0,pStage Ⅱa]と診断した。術後4か月で骨盤内,リンパ節,肺に再発を認め,術後9か月で死亡した。内分泌細胞癌は生物学的悪性度が非常に高く,予後は不良であるとされている。治療成績の改善のためには,さらなる症例の蓄積と治療方法の確立が望まれる。
目次
A 70—year—old man presented to our hospital with weight loss. A colonoscopy revealed advanced cancer in the lower rectum. Computed tomography showed a tumor larger than 5 cm in the lower rectum with metastasis to the right lateral lymph node. The patient was diagnosed with advanced locally rectal cancer, and chemoradiotherapy(35 Gy plus S—1)was added after 6 courses of mFOLFOX6, and laparoscopic abdominal perineal resection and right lateral lymph nodes dissection were performed. Histopathological examination revealed endocrine cell carcinoma(pT3[A], pN0, M0, pStage Ⅱa). Four months after the operation, recurrence was found in the pelvis, lymph nodes, and lungs, and he died 9 months after the operation. Neuroendocrine carcinoma is relatively rare, so the further accumulation of cases and establishment of treatment methods are desired.
要旨
症例は70歳,男性。体重減少を主訴に受診し,下部消化管内視鏡検査で下部直腸に3/4周性の2型病変を認め,生検では高分化管状腺癌であった。CTでは下部直腸に5 cm超の腫瘍を認め,右側方リンパ節転移を伴っていた。高度局所進行直腸癌と診断し,術前化学療法としてmFOLFOX6療法を6コース後に化学放射線療法(35 Gy+S—1)を追加し,腹腔鏡下腹会陰直腸切断術,右側方リンパ節郭清を施行した。病理組織学的検査において内分泌細胞癌[pT3(A),pN0,M0,pStage Ⅱa]と診断した。術後4か月で骨盤内,リンパ節,肺に再発を認め,術後9か月で死亡した。内分泌細胞癌は生物学的悪性度が非常に高く,予後は不良であるとされている。治療成績の改善のためには,さらなる症例の蓄積と治療方法の確立が望まれる。