Ono Reiko, Ise Norihito, Yoshioka Hiroshi, Iwasaki Wataru, Sato Kimihiko, Niwa Makoto
Division of Surgery, Yokote Municipal Hospital.
Gan To Kagaku Ryoho. 2017 Jan;44(1):83-85.
The patient was a 41-year-old woman. When she was 39 years old, she had undergone laparoscopic high anterior resection for sigmoid colon cancer without adjuvant chemotherapy. Histologically, the surgical specimen was type 2, tub2, pT4a (SE), pN0, int, INF b, ly1, v1, and pStage II. Nine months after the operation, she suffered from abdominal fullness. Laborato- rydata showed elevation of tumor markers: the CEA level was 6.48 ng/mL, the CA19-9 level was 89.70 U/mL, and the CA125 level was 662 U/mL. Computed tomographyrevealed bilateral ovarian tumors and lung and peritoneal nodules with massive ascites. Chemotherapywas started with a regimen consisting of capecitabine plus oxaliplatin(CapeOX)that included bevacizumab. After 4 courses, the sizes of the lung and peritoneal nodules had decreased and the amount of ascites was almost zero. However, the ovarian tumors had increased in size and her sense of abdominal fullness had not improved. Bilateral oophorectomy with hysterectomy was performed to alleviate her symptom. Immunohistochemically, the resected ovarian tumors were negative for cytokeratin 7 and positive for cytokeratin 20. CapeOX with bevacizumab was then resumed. However, the lung tumor had graduallyincreased in size, and therefore, she underwent partial resection of the lung for the metastatic lung tumor.
患者为一名41岁女性。她39岁时因乙状结肠癌接受了腹腔镜高位前切除术，未进行辅助化疗。组织学检查显示，手术标本为2型，tub2，pT4a（SE），pN0，int，INF b，ly1，v1，p分期为II期。术后9个月，她出现腹胀。实验室检查数据显示肿瘤标志物升高：癌胚抗原（CEA）水平为6.48 ng/mL，糖类抗原19-9（CA19-9）水平为89.70 U/mL，糖类抗原125（CA125）水平为662 U/mL。计算机断层扫描显示双侧卵巢肿瘤以及肺部和腹膜结节，并伴有大量腹水。开始采用包含卡培他滨加奥沙利铂（CapeOX）并联合贝伐单抗的化疗方案。4个疗程后，肺部和腹膜结节的大小减小，腹水量几乎为零。然而，卵巢肿瘤的大小增加，她的腹胀感并未改善。为缓解症状，进行了双侧卵巢切除术及子宫切除术。免疫组织化学检查显示，切除的卵巢肿瘤细胞角蛋白7阴性，细胞角蛋白20阳性。随后恢复使用含贝伐单抗的CapeOX方案。然而，肺部肿瘤的大小逐渐增大，因此，她接受了转移性肺肿瘤的肺部分切除术。
