演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

肺扁平上皮癌に対してpembrolizumabによる免疫療法中に切除したS状結腸癌の1例

演題番号 : P17-3

[筆頭演者]
演者)竹村 真一:1 
[共同演者]
野沢 佳弘:2、大杉 純:3、神賀 貴大:1、佐藤 好宏:1、土井 孝志:1

1:白河厚生総合病院・外科、2:白河厚生総合病院・病理部、3:白河厚生総合病院・呼吸器外科

 

The patient is 70-year-old Japanese man. He was presented with FOBT positive and right chest pain, and diagnosed as sigmoid colon cancer. He was referred to our hospital for treatment of sigmoid colon cancer and detailed examination of chest pain. Colonoscopy revealed a Borrman type II tumor in sigmoid colon, and its biopsy specimen diagnosed as a well differentiated adenocarcinoma. By FDG-PET CT and CT-guided biopsy examination, he was diagnosed as lung cancer showing SCC (max: 42.0mm) complicated with mediastinal lymphnode metastases, pleural disseminations and right pleural effusion (cT2bN3M1a, StageIVA:TMN classification). Immunohistochemistry of SCC indicated the tumor was 90-100% positive for PD-L1.Because colon cancer was asymptomatic, 1st-line immunotherapy for lung cancer with pembrolizumab was preferentially carried out. CT examination after one treatment revealed decreased pleural effusion, reduced tumor size from 47.0 to 22.4mm. But he developed skin disorders,liver dysfunction and diabetes due to the side effect of pembrolizumab and took drug holiday. During drug holiday, laparoscopic sigmoid colectomy was performed. Microscopically, the colon cancer grew in an irregular tubular structure and was characterized by a large number of lymphoid cells in the invasive carcinomatous margin, while denatured carcinoma and necrotic cells were conspicuous in carcinomatous glands. The final pathological staging was pStageIIB (T4aN0M0:TNM classification).With respect to the immunohistochemistry, the biopsy specimen showed a small number of T cells and almost negative for cytotoxic molecule expression. PD-1 was expressed on a few lymphocytes and the tumor was PD-L1-negative. However, CD3+/CD8+ T cells were infiltrated in more 70% of the invasive carcinomatous margin of the resected specimen. PD-1 expression was observed on a few lymphocytes and stromal cells and PD-L1 expression was weakly observed on a few non-neoplastic stromal cells.

キーワード

臓器別:大腸・小腸

手法別:免疫療法

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