Nakazawa Akiko, Mitsui Tetsuya, Miyata Yoichi, Ninomiya Riki, Komagome Masahiko, Maki Akira, Ozawa Fumiaki, Beck Yoshifumi
Dept. of Hepato-Biliary-Pancreas Surgery, Saitama Medical Center, Saitama Medical University.
Gan To Kagaku Ryoho. 2018 Mar;45(3):530-532.
Neuroendocrine carcinoma(NEC)is known as rapid tumor growth, high grade malignancy and poor prognosis. We report a case of huge pancreatic NEC successfully performed conversion surgery after EP therapy. A 70-year-old female, was presented to our hospital with appetite loss. CT scan revealed huge tumor, 15 cm in diameter, locating at the pancreas with possible involvement to liver, stomach, common hepatic artery, left gastric artery and gastroduodenal artery. Peritoneal dissemination and para-aortic lymph node metastasis were also suspected. EUS-FNA showed neuroendocrine carcinoma with almost 100%positive staining rate of Ki-67. We immediately started etoposide/cisplatin(EP)therapy. After 6 courses of EP, the tumor shrank remarkably and peritoneal disseminations were disappeared. Common hepatic artery and gastroduodenal artery became free from the tumor. However, after 7 courses of EP, CT and PET-CT revealed tumor re-growth. Also renal impairment could not afford to continue EP therapy. Therefore we decided to perform conversion surgery. In the guideline in Japan, there is no content specialized for surgical treatment for NEC. Moreover, second-line of chemotherapy for NEC has not been established. In the future, accumulation of NEC cases will contribute to develop effective multidisciplinary treatment.
神经内分泌癌（NEC）以肿瘤生长迅速、高度恶性和预后不良而闻名。我们报告一例巨大胰腺NEC患者，在接受EP治疗后成功进行了转化手术。一名70岁女性因食欲减退就诊于我院。CT扫描显示一个直径15厘米的巨大肿瘤，位于胰腺，可能累及肝脏、胃、肝总动脉、胃左动脉和胃十二指肠动脉。还怀疑有腹膜播散和主动脉旁淋巴结转移。超声内镜引导下细针穿刺活检显示为神经内分泌癌，Ki-67染色阳性率几乎为100%。我们立即开始依托泊苷/顺铂（EP）治疗。经过6个疗程的EP治疗后，肿瘤显著缩小，腹膜播散消失。肝总动脉和胃十二指肠动脉未受肿瘤侵犯。然而，在7个疗程的EP治疗后，CT和PET-CT显示肿瘤复发。而且肾功能损害无法承受继续EP治疗。因此我们决定进行转化手术。在日本的指南中，没有专门针对NEC手术治疗的内容。此外，NEC的二线化疗尚未确立。未来，NEC病例的积累将有助于开展有效的多学科治疗。
