title: A Case of Neuroendocrine Cell Carcinoma with Sigmoidovesical Fistula.
abstract: Colonic neuroendocrine cell carcinoma (NEC), which is a rare subtype of colon epithelial neoplasm, has been reported to show extremely aggressive characteristics with a 1-year survival rate of 20%. We report herein a resected case of NEC that manifested bacterial sepsis due to sigmoidovesical fistula. Staged surgery consisted of resecting the sigmoid colon and part of the bladder four weeks after construction of an ileostomy to alleviate septic shock. The resected specimen was histologically diagnosed as NEC invading the wall of the urinary bladder with metastasis to the regional lymph nodes. The patient underwent four cycles of FOLFOX after surgery for additional treatment of residual metastatic lymph nodes around the abdominal aorta diagnosed preoperatively. Although the patient showed stable disease measured by computed tomography scan for the first three months after surgery, he rejected additional chemotherapy thereafter, and died ten months after the initial admission due to progression of residual tumor in the urinary bladder as well as the lymph nodes. This is the first case report describing colonic NEC manifesting perforation into the urinary bladder. Although the optimal chemotherapeutic regimen for colonic NEC has not yet been established, FOLFOX may be one of the choices.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Itoh
authors.forename: Atsushi
authors.initials: A
authors.lastname: Toma
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Fuji
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mazaki
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Naito
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
references.citation: Chirurg. 2002 Aug;73(8):859-61
references.pmid: 12425166
references.citation: Cancer. 1999 Dec 1;86(11):2217-21
references.pmid: 10590360
references.citation: J Clin Gastroenterol. 1989 Jun;11(3):335-9
references.pmid: 2546989
references.citation: Nihon Shokakibyo Gakkai Zasshi. 2002 Mar;99(3):282-8
references.pmid: 11925866
references.citation: Korean J Gastroenterol. 2006 Aug;48(2):97-103
references.pmid: 16929153
references.citation: Am J Clin Oncol. 2002 Apr;25(2):160-3
references.pmid: 11943894
references.citation: J Thorac Oncol. 2008 Jan;3(1):94-7
references.pmid: 18166847
references.citation: J Clin Oncol. 2008 Jul 10;26(20):3403-10
references.pmid: 18612155
references.citation: Cir Esp. 2007 Aug;82(2):128-30
references.pmid: 17785149
references.citation: Surg Today. 1999;29(2):165-9
references.pmid: 10030743
references.citation: Clin Colorectal Cancer. 2002 Feb;1(4):243-8
references.pmid: 12450423