G-CSF産生膀胱癌の1例 : 本邦症例の検討を加えて

Abstract

We report a case of urinary bladder cancer that produced granulocyte-colony stimulating factor (G-CSF). A 56-year-old man was admitted to our hospital with the chief complaint of macroscopic hematuria. Cystoscopy demonstrated a thumb tip-sized bladder tumor. Computerized tomography and magnetic resonance imaging showed muscular invasion in the bladder, but no distant metastases. The complete blood count and laboratory examination showed leukocytosis of 25, 200/mm3 and a high G-CSF level of 145 pg/ml in the peripheral blood. Although he underwent total cystectomy and adjuvant chemotherapy using methotrexate, vinblastine, doxorubicin and cis-platinum (M-VAC) under the diagnosis of locally advanced bladder cancer, he died of progressive disease of the carcinoma about eight months after the diagnosis. A temporary decrease of white blood cell count and serum GCSF were observed just after treatment. The histopathological diagnosis was undifferentiated giant and spindle cell carcinoma of the urinary bladder (grade 3, pT3b, pN1). The tumor cells exhibited positive staining for G-CSF immunohistochemically.

56歳男。無症候性肉眼的血尿より浸潤性膀胱腫瘍を疑い入院した。WBCの増加、膀胱右三角部を中心に拇指頭大強、広基性、非乳頭状腫瘍を認めた。MRI で基部に断裂および外側壁不整の広基性腫瘍を認め、造影CTで膀胱腫瘍に起因する右水腎水尿管を認めた。生検より異型上皮細胞の充実性あるいは孤立性浸潤を認め、きわめて低分化であった。血中G-CSF高値によりG-CSF産生腫瘍を疑い、浸潤性膀胱癌T3bN0M0と判断して膀胱全摘除術および回腸新膀胱造設術を施行した。病理所見よりgiant and spindle cell carcinoma of urinary bladder、G3、pT3b、N1、v1と診断した。術後経過良好で1ヵ月後の血中G-CSF値は軽度低下し、補助化学療法M-VAC療法を施行したが、効果判定の画像所見で多発性肺転移、肺門部および骨盤内リンパ節転移を認め、血清G-CSF値は再上昇した。UFT内服で治療するが全身状態は低下し、白血球が増多して術後6ヵ月に死亡した。