膀胱原発印環細胞癌の1例

Abstract

71歳男性.患者は動悸, 息切れ, 全身倦怠感で近医を受診し, 高度の腎機能障害を指摘され紹介入院となった.所見では, 下顎骨に著明な自発痛を認めたが胸腹部に異常はなく, 検査で貧血と高度腎機能障害を認め, 膀胱洗浄尿細胞診はclass IIであった.CTで両側水腎症と膀胱壁の著明な肥厚を認め, 原因不明の腎後性腎不全と診断し, 右腎瘻造設術で腎機能は正常値まで改善した.膀胱内の観察では膀胱粘膜は広範囲で白色調, 浮腫状で, 膀胱後壁に粘膜下腫瘍様の隆起性病変を認め, 一部を生検しTURを施行した.病理所見では, 膀胱粘膜下層に異形成を伴う核が偏心性に存在する印環細胞癌が索状, びまん性に存在し膀胱筋層まで浸潤し, 骨シンチグラムではほぼ全身に異常集積を認め, 膀胱原発の印環細胞癌, 多発性骨転移と診断した.心疾患, 全身状態不良で積極的治療はできず, 1ヵ月後に癌死した

A 71-year-old man complained of dyspnea and general fatigue. His blood tests showed severe renal dysfunction. Computed tomographic scan, bone scintigram, and cystoscopy revealed primary signet ring cell carcinoma of the urinary bladder with multiple bone metastases (cT2N0M1). As the general condition of the patient was poor, nephrostomy was performed. He died one month after the diagnosis due to cancer progression. The prognosis of signet ring cell carcinoma of the bladder is poor because many cases presented at an advanced stage. Fifty cases of signet ring cell carcinoma in the urinary bladder reported in Japan are reviewed.