Ito Yu, Hashimoto Kohei, Shindo Tetsuya, Kobayashi Ko, Tanaka Toshiaki, Masumori Naoya
Department of Urology, Sapporo Medical University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 2024;115(2):94-98. doi: 10.5980/jpnjurol.115.94.
We present a case of retroperitoneal carcinosarcoma. A 48-year-old woman with left-sided abdominal pain and a 15 cm tumor in the lower left renal retroperitoneal region on computed tomography (CT) was referred to our hospital. Contrast-enhanced CT showed a well-defined tumor with contrast effect on the retroperitoneum. Magnetic resonance imaging (MRI) demonstrated a heterogeneous cystic mass and well-enhanced mural nodules in the tumor on T2-weighted images. Her levels of serum CA-125 and CA-19-9 were high at 44.7 and 143.0 U/mL, respectively. Although she was diagnosed with primary retroperitoneal mucinous cystadenocarcinoma and underwent surgical resection, the pathological diagnosis was a carcinosarcoma on the retroperitoneum. No adjuvant therapy was given. CT findings at 2 months revealed local recurrence and multiple pulmonary metastases. She received paclitaxel (175 mg/m on day 1) and carboplatin (area under the curve of 6 on day 1) (TC) every 3 weeks. After two courses of TC therapy, some pulmonary metastases disappeared and shrank, but the progression of local recurrence was observed. However, after seven total courses of TC therapy, local recurrence further progressed, with the infiltration of the abdominal wall and lumbar pain, which was determined to be progressive disease (PD). A comprehensive genomic profiling test revealed no actionable genetic mutations. She died of cancer five months after the disease recurred. Carcinosarcoma is a rare tumor with poor prognosis, for which no established treatment exists beyond surgical resection. In this case, the therapeutic agent could not be determined; however, genomic analysis should be performed to guide the treatment of carcinosarcoma in advanced cases.
我们报告一例腹膜后癌肉瘤病例。一名48岁女性,因左侧腹痛就诊,计算机断层扫描(CT)显示左肾下腹膜后区域有一个15 cm的肿瘤,遂转诊至我院。增强CT显示肿瘤边界清晰,腹膜后有强化效应。磁共振成像(MRI)在T2加权图像上显示肿瘤为异质性囊性肿块,壁结节强化明显。她的血清CA - 125和CA - 19 - 9水平分别高达44.7和143.0 U/mL。尽管她最初被诊断为原发性腹膜后黏液性囊腺癌并接受了手术切除,但病理诊断为腹膜后癌肉瘤。未给予辅助治疗。2个月后的CT检查发现局部复发和多发肺转移。她接受了每3周一次的紫杉醇(第1天175 mg/m²)和卡铂(第1天曲线下面积为6)(TC方案)治疗。经过两个疗程的TC治疗后,部分肺转移灶消失并缩小,但观察到局部复发进展。然而,在总共七个疗程的TC治疗后,局部复发进一步进展,出现腹壁浸润和腰痛,确定为疾病进展(PD)。全面基因组分析检测未发现可靶向的基因突变。疾病复发五个月后,她死于癌症。癌肉瘤是一种罕见肿瘤,预后较差,除手术切除外尚无既定的治疗方法。在本病例中,无法确定治疗药物;然而,对于晚期癌肉瘤病例,应进行基因组分析以指导治疗。