Lynch H T, Thorson A G, Smyrk T
Department of Preventive Medicine, Creighton University School of Medicine, Omaha, Nebraska.
Cancer. 1995 Feb 15;75(4):936-8. doi: 10.1002/1097-0142(19950215)75:4<936::aid-cncr2820750407>3.0.co;2-q.
Sulindac is reported to induce regression of colonic adenomas. However, its role as a chemoprophylactic agent for people with familial adenomatous polyposis (FAP) is under consideration.
This case report describes a patient with FAP in whom rectal adenocarcinoma developed 37 years after prophylactic colectomy and 15 months after beginning a course of sulindac. She received endoscopic follow-ups every 3 months during 15 months of 150-mg twice-daily sulindac administration. At 12 months, an endoscopic examination was unremarkable; at 15 months, endoscopic examination revealed several polyps and a flat ulcerated lesion.
Rectal carcinoma developed in a patient 15 months after beginning chemoprophylaxis: there was metastatic adenocarcinoma in 6 of 20 perirectal lymph nodes. In addition to the carcinoma, rectal mucosa contained two adenomas and multiple foci of adenomatous changes in flat mucosa.
Sulindac may not alter the pathogenesis of FAP. Patients undergoing sulindac chemoprevention must be monitored closely, including endoscopic examination. Endoscopic surveillance should include an aggressive biopsy approach because the absence of polyps does not prove the absence of neoplastic change.
据报道，舒林酸可使结肠腺瘤消退。然而，其作为家族性腺瘤性息肉病（FAP）患者化学预防剂的作用正在研究中。
本病例报告描述了一名FAP患者，该患者在预防性结肠切除术后37年以及开始服用舒林酸疗程15个月后发生了直肠癌。在每天两次服用150毫克舒林酸的15个月期间，她每3个月接受一次内镜随访。在12个月时，内镜检查无异常；在15个月时，内镜检查发现了几个息肉和一个扁平溃疡病变。
患者在开始化学预防15个月后发生了直肠癌：20个直肠周围淋巴结中有6个出现转移性腺癌。除癌外，直肠黏膜包含两个腺瘤以及扁平黏膜中多个腺瘤样改变灶。
舒林酸可能不会改变FAP的发病机制。接受舒林酸化学预防的患者必须密切监测，包括内镜检查。内镜监测应采用积极的活检方法，因为息肉的不存在并不能证明不存在肿瘤性改变。
