Spontaneous Regression Of Peritoneal Carcinomatosis From A Rectal Cancer.
abdelrazeq, A. S., Lund, J. N., & Leveson, S. H. (2005). spontaneous regression of peritoneal carcinomatosis from a rectal cancer. European journal of gastroenterology & hepatology, 17(12), 1421–1423. https://doi.org/10.1097/00042737-200512000-00025
View Original Source →Abstract
Spontaneous regression of adult solid tumours is rare. Here, we present the case of a 51-year-old man who underwent a curative resection for an adenocarcinoma of the rectum in 1989. He remained well until 12 months after surgery when he developed a large-fixed mass proximal to the anastomosis, which was treated with radiotherapy but did not respond. Shortly after, he presented with intestinal obstruction caused by extensive intraperitoneal metastases. At laparotomy, a palliative entero-enterostomy and ileostomy were performed. Biopsies from the peritoneal lesions showed features typical of metastatic adenocarcinoma. The patient did not receive any additional therapy. However, his condition continued to improve; he remains disease free and well at present (May 2005). A review of the literature revealed two cases of spontaneous regression of peritoneal carcinomatosis secondary to a rectal cancer; we report the third case and discuss some of the reasons potentially responsible for the regression.
Case Details
Disease Location
Colon + peritoneum mets
Personal Characteristics
51-year-old man
Clinical Characteristics
6- months history of intermittent diarrhoea and rectal bleeding, clinical examination and rigid sigmoidoscopy to a distance of 13cm were normal, a barium enema confirmed the presence of a neoplastic lesion at the recto-sigmoid junction. Histological examination confirmed that the tumor was a duke’s b moderately differentiated adenocarcinoma, with no vascular invasion and clear resection margins. The patient re-presented 1 year later with urgency, tenesmus and rectal bleeding. Rigid sigmoidoscopy confirmed the presence of a large mass, 5cm proximal to the staple line and 10 cm from the anal verge. Biopsies from this mass showed histological features similar to those of the original cancer. Two years later, he underwent surgery for a frozen-pelvis.
Remission Characteristics
Five years later, he presented with haematuria and anemia. Computerized tomography imaging of the abdomen and pelvis and the tumour markers were normal. Multiple biopsies at the last laparotomy, done for frozen pelvis, and sigmoidoscopic biopsies showed fibrosis and extensive chronic inflammatory cells infiltration and no evidence of malignancy.
Treatment & Mechanisms
Proposed Remission Mechanisms
Antigen-driven or carcinogen-driven and regressed following diminution in antigen or carcinogen exposure caused by faecal diversion by an ileostomy.
Clinical Treatment
Anterior resection at the recto-sigmoid junction. 1 year later: radiotherapy to the pelvis with no response. Laparotomy was performed and extensive intraperitoneal metastases were found. Palliative bypass and ileostomy were performed.