Effectiveness of Chemotherapy with Cisplatin and 5-Fluorouracil against Lung Metastasis from Anal Neuroendocrine Cell Carcinoma

Takashi Ohshima¹⁾, Yasunobu Yamazaki¹⁾, Tatsuo Makino¹⁾, Katsumi Go¹⁾, Hiroshi Kanaya¹⁾, Takashi Chishima¹⁾, Hiroshi Harada¹⁾, Takashi Suda¹⁾, Nobuko Nakamura²⁾ and Toshio Imada³⁾

Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital¹⁾, Department of Pathology, Saiseikai Yokohamashi Nanbu Hospital²⁾, Yokohama City University Medical Center, Gastroenterological Center³⁾

Anal neuroendocrine cell carcinoma is extremely rare. To our knowledge, only 4 cases have been reported in Japan, all of which had early metastases and a poor outcome. We report a case of anal endocrine cell carcinoma with early pulmonary metastases that responded to a combination of 5-fluorouracil (5-FU) and cisplatin (CDDP). A 51-year-old woman was admitted beccause of bleeding at defecation. A palpable mass was present in the left inguinal region. Rectal endoscopy revealed a protruding lesion extending to the dentate line and left inguinal lymph node enlargement. Biopsy showed a poorly-differentiated anorectal adenocarcinoma metastacizing to the left inguinal lymph nodes. An abdominoperineal resection with a lateral excision and bilateral inguinal lymph node dissection was perfomed. Histopathological examination of the surgical specimens revealed positive Grimelius and chromogranin A staining in tumor tissue, indicating a neuroendocrine cell carcinoma. On discharge, treatment with 600 mg/day p.o. of tegafur was begun. About 1 month after surgery, plain chest radiography and computed tomography showed multiple lung metastases. Continuous intravenous infusion of 5-FU (500 mg/m²/day) with daily CDDP (15 mg/m²/day) was given on days 1 to 5 of a 4-week cycle. Tegafur (600 mg/day) was administered orally on days 6 to 28. Pulmonary metastatic nodes had resolved completely at the end of the first cycle. A total of six cycles of chemotherapy were given. To date, 1 year and 6 months after surgery, there is no evidence of metaastatic recurrence.

Key words
neuroendcrine cell carcinoma, cisplatin, 5-fluorouracil

Reprint requests
Takashi Ohshima Yokohama City University Medical Center, Gastroenterological Center 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
December 18, 2002

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