@article{oai:redcross.repo.nii.ac.jp:00017734,
 author = {松本, 彩 and 日野, 麻世 and 濱口, 史香 and 春日, 摩耶 and 山西, 恵 and 山西, 優紀夫 and 横山, 玲子 and 山村, 省吾 and 坂田, 晴美 and 豊福, 彩 and 吉田, 隆昭},
 journal = {日本赤十字社和歌山医療センター医学雑誌, Medical Journal of Japanese Red Cross Wakayama Medical Center},
 month = {Mar},
 note = {子宮体癌、高頻度マイクロサテライト不安定性に対してPembrolizumabを使用し偽増悪後に著効したが、免疫関連副作用のため死亡したと思われる1例を経験したため報告する。症例は56歳、歩行障害を主訴に受診し、重症貧血およびCTにて骨盤内腫瘤と十二指腸穿孔をみとめた。MRIで筋層浸潤のある子宮内腫瘍をみとめ、腟内の白色腫瘍を生検したところAdenocarcinomaであり子宮体癌の診断にて手術を施行した。術後病理組織診断はHigh-grade carcinomaであった。化学療法は奏効せずPembrolizumab投与を開始した。3回投与後腫瘍径の増減にばらつきがあったが、腫瘍マーカーは漸減した。6回投与後にはいずれの腫瘤も著明に縮小した。8回投与時に全身倦怠感や食思不振が出現し、3週間後に傾眠傾向、脱水、心房細動などをみとめて入院となった。Pembrolizumabによる下垂体機能不全と診断しステロイド治療を行うも入院後5日に心不全のため永眠された。婦人科領域においてPembrolizumabに関する報告は少なく他科の知見を交えながら考察する。, We report a case of death from hypopituitarism thought to be caused by immune-related adverse events in a patient with corpus cancer who showed pseudoprogression and was treated effectively with pembrolizumab. The patient was a 56-year-old woman with difficulty walking who was found to have severe anemia at our hospital. A computed tomography scan showed a mass in the pelvis and a duodenal perforation. A magnetic resonance imaging examination revealed an invasive intrauterine tumor. Histology revealed adenocarcinoma. She was diagnosed with corpus cancer and underwent surgery with abdominal total hysterectomy and bilateral salpingo-oophorectomy. The postoperative histopathological diagnosis was corpus cancer and high-grade carcinoma. Chemotherapy was not effective, and she received pembrolizumab. After 3 cycles of pembrolizumab, one tumor increased in size, and the other decreased in size; the tumor marker levels were consistently reduced. After 6 cycles of pembrolizumab, all of the tumors were markedly reduced. After 8 cycles of pembrolizumab, she suffered from physical exhaustion and anorexia. Three weeks later, she presented with somnolence, dehydration and atrial fibrillation, causing her to be admitted to the hospital. She was diagnosed with hypopituitarism, which was thought to be an immune-related adverse event of pembrolizumab, and received steroid therapy, but she died five days after hospitalization. There are few reports of pembrolizumab from gynecology departments, so we wish to share the details of this case with other departments.},
 pages = {83--87},
 title = {子宮体癌にPembrolizumabを使用し著効したが免疫関連副作用と思われる下垂体機能不全を契機に死亡した1例},
 volume = {38},
 year = {2021}
}