A case of endocrine cell carcinoma of the ascending colon successfully treated with mFOLFOX6 plus bevacizumab

症例は70歳代,男性.腹痛,腹部膨満を主訴に精査が行われた.大腸内視鏡検査で上行結腸に腫瘍を認め,生検で混合型小細胞癌が疑われた.遠隔転移を認めたが,腸閉塞の発症が危惧されたため,右半結腸切除術を施行した.摘出標本の病理組織診断でChromograninA,Synaptophysinに陽性を示し,上行結腸原発の内分泌細胞癌と診断された.最終病期診断はStageIV(SiN3M1)であった.術後1ヵ月のCTで多発リンパ節転移,肝転移,腰椎転移を認め,Bevacizumab併用mFOLFOX6療法を開始した.4クール施行後のCTで転移巣の著明な縮小を認め,以後も化学療法を継続し,無増悪で生存中である.大腸内分泌細胞癌は稀であり,有効な化学療法が確立されておらず,分子標的薬を用いた化学療法の報告も少ない.大腸内分泌細胞癌と化学療法について,文献的考察を加えて報告する.

We report a case of effective treatment of mFOLFOX6 plus bevacizumab for endocrine cell carcinoma of ascending colon. A 79-year-old man was admitted for abdominal pain and fullness. Colonoscopy showed a tumor with ulceration in the ascending colon and the tumor was diagnosed by the biopsy as carcinoma combined with small cell carcinoma. Right hemicolectomy was done(stageIV,SiN3M1)and endocrine cell carcinoma was diagnosed finally by histological examination because of positive immunohistochemical staining with chromograninA and synaptophysin. One month after the surgery, multiple lymph nodes, liver and lumbar spine metastasis were found in CT. mFOLOFOX6 plus bevacizumab chemotherapy was started. After 4 cycles of the therapy, the tumor diminished and the patient has remained progression free. Endocrine cell carcinoma of the colon is rare and an effective chemotherapy has not been established. We report this case with a review of the literature.

大腸内分泌細胞癌

化学療法

Bevacizumab