Abstract：
A 75-year-old woman was admitted to our hospital with suspected gastrointestinal perforation and underwent emergency surgery. Bladder perforation was revealed during the surgery, and she was referred to our department. We detected a tumor on the apex of the bladder and performed partial resection of the bladder. Based on histopathological examination, a diagnosis of urachal cancer was established. Gemcitabine and cisplatin (GC) therapy was administered as an adjuvant therapy because of the high risk of peritoneal dissemination. She had the purulent spondylitis and gluteus medius abscess at the first course of GC therapy. We stopped GC therapy within the first course due to the adverse events and decreased performance status. Computed tomography revealed tumor recurrence in the pelvis three months after discontinuation of GC therapy. As the companion diagnostics revealed MSI-High, we administrated pembrolizumab. She was taking prednisolone 5 mg for SLE, but stable disease was observed after 5 courses of pembrolizumab. However, pembrolizumab was discontinued for eight months due to the stent graft insertion for the common iliac artery aneurysm. She had progressive disease after eight months interval of treatment. We restarted pembrolizumab but she was hospitalized for tumor fever after a total of eight courses. The patient died a month later. This seems to be the first case wherein pembrolizumab was administered for urachal cancer with MSI-High.
摘要：
一名75岁的妇女因怀疑胃肠道穿孔而入院，并接受了紧急手术。手术中发现膀胱穿孔,她被转介到我们部门.我们在膀胱顶端检测到一个肿瘤，并对膀胱进行了部分切除。根据组织病理学检查，确定了脐静脉癌的诊断。吉西他滨和顺铂（GC）疗法作为辅助疗法，因为腹膜播散的风险很高。在GC治疗的第一个疗程中，她患有化脓性脊柱炎和臀中脓肿。由于不良事件和表现状态下降，我们在第一个疗程内停止了GC治疗。计算机断层扫描显示在停止GC治疗三个月后骨盆肿瘤复发。随着伴随诊断显示MSI-High,我们给药了派博利珠单抗.她正在服用5毫克泼尼松龙治疗SLE，但在5个疗程的pembrolizumab治疗后观察到病情稳定.然而,pembrolizumab由于为髂总动脉瘤插入支架移植物而停药8个月.治疗间隔八个月后，她患有进行性疾病。我们重新启动了pembrolizumab，但她在总共八个疗程后因肿瘤发热住院。患者一个月后死亡。这似乎是其中派姆单抗与MSI-High一起用于脐尿管癌的第一种情况。
