Yamanashi Takahiro, Nishi Tomohiko, Yamamoto Tatsuma, Toriumi Fumiki, Koshida Yoshitomo, Mukai Kiyoshi, Shimoyama Yutaka
Dept. of Surgery, Tokyo Saiseikai Central Hospital.
Gan To Kagaku Ryoho. 2014 Jan;41(1):107-12.
A 77-year-old man who complained of melena was admitted to our department. Colonoscopy revealed a type 2 tumor in the hepatic flexure of the ascending colon. Biopsy examination revealed a poorly differentiated adenocarcinoma. Abdominal computed tomography(CT)revealed 3 tumors within the posterior segment of the right hepatic lobe. Initially, a right hemicolectomy was performed. Immunohistochemically, the tumor was diagnosed as an endocrine cell carcinoma. After surgery, a capecitabine, oxaliplatin, and bevacizumab(CapeOX/BEV)regimen was administered. However, after 5 chemotherapy courses, abdominal CT revealed enlargement of the 3 tumors in the posterior segment of the right hepatic lobe. There was no metastasis besides the liver metastasis. The patient underwent a radical hepatectomy of the posterior segment. At 8 months post-surgery, the patient remains alive and well. Endocrine cell carcinoma of the colon and rectum is usually malignant and is associated with a very poor prognosis because of rapid hematogenous or lymphogenous metastasis. Effective multimodal treatment regimens, including surgery and new chemotherapies such as molecular targeted therapies, should be established to improve the prognosis of patients with endocrine cell carcinomas of the colon and rectum.
一名主诉黑便的77岁男性入住我院。结肠镜检查发现升结肠肝曲处有一个2型肿瘤。活检检查显示为低分化腺癌。腹部计算机断层扫描(CT)显示右肝叶后段有3个肿瘤。最初,进行了右半结肠切除术。免疫组化检查显示,该肿瘤被诊断为内分泌细胞癌。术后给予卡培他滨、奥沙利铂和贝伐单抗(CapeOX/BEV)方案化疗。然而,在5个化疗疗程后,腹部CT显示右肝叶后段的3个肿瘤增大。除肝转移外无其他转移。患者接受了右肝叶后段根治性肝切除术。术后8个月,患者仍存活且状况良好。结肠和直肠内分泌细胞癌通常具有恶性,由于血行或淋巴转移迅速,预后很差。应建立包括手术和新的化疗(如分子靶向治疗)在内的有效的多模式治疗方案,以改善结肠和直肠内分泌细胞癌患者的预后。