2021 Volume 46 Issue 2 Pages 138-147
During surveillance after surgery for a duodenal adenoma, a 59-year-old woman underwent a thorough examination because of a positive fecal occult blood test and an elevated serum tumor marker level. She was subsequently diagnosed as having an appendix adenocarcinoma (cT4N0M0, cStage Ⅱ) and underwent a planned laparoscopic ileocecal resection and D3 lymphadenectomy. Since the operative findings showed widespread peritoneal dissemination around Douglas’ pouch, we determined that a radical resection was impossible. She underwent a laparoscopic ileocecal resection and D2 lymphadenectomy and was scheduled to receive intensive combined therapy. The pathological findings showed the presence of a goblet cell carcinoid of the appendix (T4a, N1b[2/7], H0, P3, M1b, pStage ⅣB). We feared that the use of bevacizumab could lead to the perforation of the peritoneal disseminated tumor, so systemic chemotherapy with mFOLFOX6 + panitumumab was instead performed. The chemotherapy was continued for about 18 months, but a bowel obstruction caused by peritoneal metastasis and perforation due to a worsening of ileus was observed on postoperative day 620, requiring emergency surgery. Thereafter, the chemotherapy was discontinued, and she died 830 days after her first surgery. One previous report of the use of panitumumab for unresectable GCC has been published in Japan, but the present report is the first case in which panitumumab was used as a first-line treatment.
