We report the case of a 60-year-old Japanese man with a metastatic brain tumor that caused ataxia. As a consequence of resection of a cerebellar tumor, the tumor was diagnosed as a poorly differentiated adenocarcinoma with choriocarcinomatous features. The patient underwent bronchoscopy, leading to a diagnosis of the same histology as the brain tumor. After the administration of first-line chemotherapy and maintenance therapy due to progressive disease, he was given nivolumab and obtained a partial response; however, 11-months later, computed tomography showed tumor progression. Our experience suggests that nivolumab has strong activity, even in patients with a rare form of lung cancer.
BackgroundPeutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract. It is associated with a high risk of malignancy in the gastrointestinal tract, as well as in other organs. We report a case of colon cancer at the anastomotic site that occurred 18 years after high anterior resection of the rectum for intussusception caused by Peutz-Jeghers polyposis.Case presentationA 31-year-old man with PJS, who had undergone high anterior resection of the rectum for intussusception at the age of 12, presented to our hospital complaining of hematochezia. Colonoscopy revealed a hemorrhagic tumor protruding from the anastomotic site, which was histologically diagnosed as an adenocarcinoma. We performed a low anterior resection of the rectum including the anastomotic site, with combined resection of the strongly adherent ileum. Histological examination revealed that the adenocarcinoma had developed from the submucosal area, where the normal rectal mucosa had been incorporated into the stromal and bone tissues, resulting in heterotopic ossification in the anastomotic region. These findings suggested that the reconstructive surgical procedure or postoperative complications, such as anastomotic leakage, had formed the cavity where the cancer had developed.ConclusionsWe concluded that the cancer might be derived from the rectal mucosa with malignant potential that was present in the anastomotic region and exacerbated by the presence of chronic inflammation in the cavity after the patient’s initial operation.
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