お知らせ

木村敏雄先生のご逝去を悼む／博士学位取得者一覧／人事異動報

A Case of Advanced Prostate Fibrosarcoma that Reacted Well to Chemotherapy

Prostate fibrosarcoma is an extremely rare tumor for which complete excision has been the mainstay of treatment. Although chemotherapy has been attempted in cases with positive surgical margins and/or advanced stage disease, the effectiveness of this therapy has not been established. Herein, we report a case of advanced prostate fibrosarcoma that reacted well to chemotherapy. A 40-year-old man was referred for treatment of a large prostatic tumor with multiple lung, liver, and bone metastases. Needle biopsy of the prostate revealed that the tumor was a high-grade undifferentiated sarcoma. Chemotherapy with doxorubicin and ifosfamide was administered. After five courses of chemotherapy, the primary prostate tumor decreased markedly, and the lung and liver metastases almost disappeared. Radical cystoprostatectomy and ileal conduit formation were performed. Pathological diagnosis was fibrosarcoma. Another three courses of doxorubicin and ifosfamide therapy were performed, and doxorubicin was replaced by etoposide because the maximum dose of doxorubicin was reached. However, the effectiveness of the second-line therapy was poor, and the tumor progressed again. The patient died of lung metastasis 15 months later

Peritumoral steatosisを呈した膵神経内分泌腫瘍肝転移の一例

症例は49歳男性。前医で薬剤性肝障害が疑われ経過を見ていた所、掻痒感増強と肝胆道系酵素上昇を認め、当院消化器内科を紹介。腹部dynamic CTで、膵頭部に動脈相で強く増強され平衡相まで増強効果が持続する腫瘤を認めた。また、肝右葉には多発肝病変を認め同様の造影挙動を示したが、病変周囲に増強されない低吸収値域を伴っていた。EOB-MRIのTIWI out-of phaseで、肝病変周囲の信号が低下し、辺縁部に脂肪を伴う病変と考えられた。亜全胃温存膵頭十コ旨腸切除 (SSPPD) および肝右葉部分切除が施行された。組織学的には、膵頭部病変は神経内分泌腫瘍(NET) の所見であった。肝病変もNETの転移である事を確認したが、肉眼的に白色調の腫瘍周囲に脂肪肝が見られ、病理組織学的にも腫瘍を取り囲むように限局性脂肪肝が認められた。Peritumoral steatosisと呼ばれる病態で、NETの肝転移で報告が散見される比較的稀な所見である。Peritumoral steatosisの検出には、chemical shift imagingが有用であった