Yokomatsu Hideaki, Katsuragi Kei, Xiang Zhang, Shibutani Masatsune
Dept. of Surgery, Moriguchi Ikuno Memorial Hospital.
Gan To Kagaku Ryoho. 2021 Dec;48(13):1673-1675.
A 48-year-old man visited our hospital complaining of abdominal pain constipation and mucous bloody stool. He was diagnosed rectal cancer with remarkable local infiltration in the pelvic organs and no distant metastasis. The pathological diagnosis was poorly differentiated adenocarcinoma and signet ring cell carcinoma. He was administered neoadjuvant chemoradiotherapy(45 Gy/30 Fr, S-1 100 mg/day 2-weeks administration, 1-week withdrawal)and underwent abdominal perineal rectal amputation. No cancer cells remained in the excised organs, so he was diagnosed with pathologic complete response(pCR). The serum CEA level decreased from 35.1 to 5.9 ng/mL at this point. Due to recurrence of peritoneal dissemination during postoperative adjuvant chemotherapy(CapeOX), the regimen was changed to FOLFIRI plus Pmab. After 4 courses of FOLFIRI plus Pmab, he complained dizziness and headache. Therefore, head computed tomography and magnetic resonance imaging were performed. However, there were no abnormal findings. An evaluation of his cerebrospinal fluid resulted in a diagnosis of meningeal carcinomatosis by fluid cytology(adenocarcinoma/class Ⅴ). His medical condition worsened rapidly and he ultimately died 2.5 months after the onset of his headache. The serum CEA level ultimately reached 2,992.6 ng/mL. The patient had been deemed to have pCR following the administration of neoadjuvant chemoradiation and surgery. His serum CEA level had increased continuously during the early period of postoperative chemotherapy without any abdominal imaging or neurological findings. After the onset of the primary symptoms of meningeal carcinomatosis, his condition deteriorated rapidly. When we encounter patients with colorectal cancer, especially those with poorly differentiated adenocarcinoma, and a continuously increasing CEA level despite no remarkable findings, we should suspect meningeal carcinomatosis and perform further examinations, including sampling the cerebrospinal fluid.
一名48岁男性因腹痛、便秘和黏液血便前来我院就诊。他被诊断为直肠癌，盆腔器官有明显局部浸润，无远处转移。病理诊断为低分化腺癌和印戒细胞癌。他接受了新辅助放化疗（45 Gy/30次，S-1 100毫克/天，给药2周，停药1周），并接受了腹会阴直肠切除术。切除的器官中未残留癌细胞，因此他被诊断为病理完全缓解（pCR）。此时血清癌胚抗原（CEA）水平从35.1降至5.9纳克/毫升。由于术后辅助化疗（CapeOX）期间出现腹膜播散复发，治疗方案改为FOLFIRI加帕尼单抗。在接受4个疗程的FOLFIRI加帕尼单抗治疗后，他出现头晕和头痛。因此，进行了头部计算机断层扫描和磁共振成像检查。然而，未发现异常。对其脑脊液进行评估，通过脑脊液细胞学检查（腺癌/Ⅴ级）诊断为脑膜癌转移。他的病情迅速恶化，最终在头痛发作后2.5个月死亡。血清CEA水平最终达到2992.6纳克/毫升。该患者在接受新辅助放化疗和手术后被认为达到了pCR。在术后化疗早期，他的血清CEA水平持续升高，而腹部影像学检查和神经系统检查均无异常发现。脑膜癌转移的主要症状出现后，他的病情迅速恶化。当我们遇到结直肠癌患者，尤其是低分化腺癌患者，且CEA水平持续升高而无明显异常发现时，应怀疑脑膜癌转移并进行进一步检查，包括采集脑脊液样本。
