Saegusa Yoshitaka, Akabane Shintaro, Shimomura Manabu, Okuda Hiroshi, Yano Takuya, Mochizuki Tetsuya, Inoue Wako, Yamaguchi Mizuki, Yamaguchi Shinji, Sentani Kazuhiro, Yamauchi Masami, Tokumo Kentaro, Ohdan Hideki
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Department of Molecular Pathology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Surg Case Rep. 2024 Sep 19;10(1):220. doi: 10.1186/s40792-024-02010-9.
Rectal neuroendocrine carcinomas (NECs) are rare and associated with poorer prognoses compared to conventional adenocarcinomas. The efficacy of adjuvant chemotherapy for resectable rectal NECs remains uncertain. Herein, we present a case of rectal NEC successfully treated with postoperative chemotherapy using irinotecan plus cisplatin.
A 48-year-old woman with a history of endometrial cancer presented with an intramural rectal tumour detected on follow-up imaging. Colonoscopy revealed a 30 mm submucosal tumour, and laparoscopic low anterior resection was performed. Histopathological examination showed poorly differentiated atypical cells with solid growth patterns. Metastasis from the uterine cancer was ruled out due to histological differences between the primary uterine tumour and the rectal lesion, as well as the absence of hormone receptor immunohistochemical expression. Further immunohistochemical analysis revealed diffuse CD56 positivity, a high mitotic rate (> 20/10 high power fields) and a Ki-67 labelling index exceeding 70%. Based on these findings, a diagnosis of rectal NEC, T3N0M0, Stage IIB (UICC 8th edition), was established. Given the aggressive nature of the tumour evidenced by a high Ki-67 labelling index, adjuvant chemotherapy comprising six cycles of irinotecan plus cisplatin was administered to mitigate the risk of recurrence. At the 3-year follow-up, the patient was free of disease recurrence.
This case highlights the importance of multidisciplinary surgical interventions followed by adjuvant chemotherapy in managing rectal NECs.
直肠神经内分泌癌（NECs）较为罕见，与传统腺癌相比，预后较差。可切除直肠NECs辅助化疗的疗效仍不确定。在此，我们报告一例直肠NEC患者，术后使用伊立替康联合顺铂化疗成功治疗。
一名有子宫内膜癌病史的48岁女性，在随访影像学检查中发现直肠壁内肿瘤。结肠镜检查发现一个30毫米的黏膜下肿瘤，遂行腹腔镜低位前切除术。组织病理学检查显示为低分化非典型细胞，呈实性生长模式。由于原发性子宫肿瘤与直肠病变的组织学差异，以及缺乏激素受体免疫组化表达，排除了子宫癌转移。进一步的免疫组化分析显示弥漫性CD56阳性、高有丝分裂率（>20/10高倍视野）和Ki-67标记指数超过70%。基于这些发现，确诊为直肠NEC，T3N0M0，IIB期（国际抗癌联盟第8版）。鉴于高Ki-67标记指数所证明的肿瘤侵袭性，给予六个周期的伊立替康联合顺铂辅助化疗，以降低复发风险。在3年的随访中，患者无疾病复发。
该病例强调了多学科手术干预后辅助化疗在直肠NECs治疗中的重要性。
