病理剖検例よりみた膀胱癌の転移について (附: 京大泌尿器科20年間の病理剖検例の統計的観察)

Abstract

An autopsy survey of the bladder cancer with special reference to its metastasis was made:on 33 necropsied cases seen in Urological Dep. of Kyoto University Hospital dur ing the past 20 years from 1945 to 1965. The similar survey was made on 306 cases recorded in the Annal of the Pathological Autopsy Cases in Japan during the past 5 years from 1958 to 1962. The f ollowing results were obtained ; 1) Concerning the age distribution, the heavy concentrations in the fifth, sixth and seventh decade (82.9%) were seen in the cases of Ann. Path. Aut. Cases Jap. 2) In the cases of Ann. Path. Aut. Cases Jap., 71% were males with th e male to female ratio about 7 : 3. 3) As cell type of the tumors, 18 cases of transitional cell carcinoma, 6 of squamous cell carcinoma, 6 of undifferentiated carcinoma, 2 of adenocarcinoma and 1 of mixed type were confirmed for the cases of Kyoto University Hospital, while 143 cases of transitional cell carcinoma, 41 of squamous cell carcinoma, 18 of undifferentiated carcinoma, 8 of adenocarcinoma, 5 of mixed type and 91 of unknown cases were seen among the total of 306 cases recorded in the Ann. Path. Aut. Cases Jap. 4) Incidence of metastasis was 69.7 % among 33 cases of Kyoto Univ. and 56.9% among 306 cases of Ann. Path. Aut. Cases Jap. The mode of metastasis was lymphogenous in 78.3%, hematogenous in 56.6% and combined in 34.8% in the cases of Kyoto Univ., while it was lymphogeneous in 77.6%, hematogenous in 72.5% and combined in 50.0% in the cases of Ann. Path. Aut. Cases Jap. 6) The sites of metastasis were in lymphnodes in 57.5%, in lungs in 27.3%, in liver in 6.1%, in bone in 12.4%, in kidneys in 6.1%, in adrenal glands in 9.1%, and peritoneum with carcinomatous peritonitis in 21.2% for the Kyoto Univ. cases, while they were in lymphnodes in 44.1%, in lungs 25.2%, in liver in 20.6%, in bone in 12.4%, in kidneys in 5.9%, in adrenal glands in 3.9%, in peritoneum with carcinomatous peritonitis in 6.8% an d in pleura with carcinomatous pleuritis in 3.6% for the Ann. Path. Aut. Cases Jap. cases. 7) Among the cases with pulmonary metastases, 46.8% were accompanied with h epatic metastases for the cases of Ann. Path. Aut. Cases Jap. 8) The type of hematogenous metastasis of the bladder cancer seems to be the Vena cava type (Walter's III type), in which the lungs are the first filter, so that many pulmonary metastases were observed in the bladder cancer. 9) The metastasized lymphnodes were retrop e ritoneal in 60%, pelvic in 30.4%, pulmonary hilar and peribronchial in 26.7%, mesenteric in 17.0%, inguinal in 9.5%, supraclavicular in 8.9% and cervical in 5.9% for the cases of Ann. Path. Aut. Cases Jap. 10) The relationship between the grading of tumor cell and metastasis wa s impressive. No low grade (grade I or II) case was seen among 23 cases with metastasis in the series of Kyoto Univ. All of the metastasized cases were high grading (grade III or IV). 11) The relationship between the staging of infiltration and metastasis sho w ed : B1 in 3 cases, B2 in 7 cases and C in 13 cases among 23 cases with metastasis in the series of Kyoto Univ. Sta t i stic observations INe re made on the necropsied cases in the series of Urological Department of Kyoto Univ. Hosp. The total number of the necropsied cases was 108 which was 45.6% of all death of the same periods. Among them 70.4% were males. The most heavy concentration was seen in the sixth decase followed by in the fifth decade and in the seventh decade. The frequency of diagnosis in these necropsied cases was the fo l lwing order : bladder tumor, urogenital tuberculosis, chronic renal insufficency, prostatic tumor, surgical death, renal tumor and urolithiasis.