Use of endoscopic ultrasound-guided fine needle aspiration of the pancreas to diagnose a case of primary linitis plastica of the colon with retroperitoneal dissemination.

A 54-year-old man had previously undergone curative sigmoidectomy for poorly differentiated adenocarcinoma with a signet-ring cell component of the sigmoid colon, which was characterized morphologically by stenosis and inelasticity of the colon (linitis plastica). Six weeks after surgery, the patient developed stenosis of the right ureter. Disseminated sigmoid cancer was suspected, and chemotherapy was started. Nine months after initiation of chemotherapy, obstructive jaundice was observed which was due to stenosis of the distal bile duct (BD). Although computed tomography showed no evident metastatic lesion that could cause the stenosis, swelling of the entire pancreas was evident compared to that of 11 months earlier. Endoscopic ultrasound (EUS) also did not detect any focal masses in the head of the pancreas, although there was a diffuse hypoechoic change in the entire pancreas. Histopathology of the stenotic BD and biopsy specimen from the head of the pancreas showed no malignant cells. Two months after the initial endoscopic bile duct drainage, the patient was admitted again for epigastric pain. A second EUS fine needle aspiration (EUS-FNA) of the head of the pancreas was performed and showed poorly differentiated carcinoma with some signet-ring cells. This finding provided histological confirmation of a disseminated pancreatic lesion of the previously resected linitis plastica of the sigmoid colon. This is a rare case of disseminated pancreatic lesion from primary linitis plastica of the colon diagnosed by EUS-FNA.

[A case of fluoropyrimidine-resistant recurrent colon cancer successfully treated with weekly administration of irinotecan].

We report a case of fluoropyrimidine-resistant recurrent colon cancer with liver and paraaortic lymph node metastases successfully treated with weekly administration of irinotecan (CPT-11). The patient was a 70-year-old man who underwent rt-colectomy for advanced colon cancer in January 2008. After the operation, adjuvant chemotherapy with uracil/tegafur and oral l-leucovorin was started and continued. However, the CEA level increased after six months, so we switched to CPT-11 at a dose of 100 mg/m2/day for 3 consecutive weeks followed by a week rest. CEA decreased to within the normal range after administration of 4 courses, and CT scan revealed metastatic lesions were reduced after 6 courses. Grade 1 general fatigue, nausea, diarrhea and grade 2 anemia and alopecia were noted, but no serious adverse reaction appeared. After that, CEA slightly increased, so the interval of administration was changed to bi-weekly in consideration of the adverse effect, restarted, and is now continuing. This was then restarted as a bi-weekly treatment, and is being continued now. It is thought this treatment may be simple, easy and promising second-line chemotherapy for uracil/tegafur and oral l-leucovorin-resistant metastatic colorectal cancer.