腟転移をきたした尿路移行上皮癌の1例

Abstract

74歳女.主訴は不正性器出血であった.過去17年間に表在性膀胱癌の膀胱内再発を繰返し計4回のTUR-BTを施行され, 3年前には膀胱癌の再発を認め単純膀胱全摘術が施行された.今回, 内診で腟粘膜の数ヶ所にびらんと発赤を認め, 同部位の生検でTCCの病理学的診断を得て, 尿路上皮癌の腟転移と診断した.この時点で多臓器への転移再発を認めなかったので, 根治的に子宮腟尿道全摘術を施行した.病理組織学的には腟粘膜上3ヶ所にTCC(G3)が腟粘膜から浅筋層に浸潤する像を認めた.術後9ヵ月, 骨盤内再発・鼠径部リンパ節転移を認め, 化学療法を施行したが, 皮膚・骨転移をきたし死亡した.尿路上皮癌が腟粘膜に転移をきたした非常に稀な症例であった

A 74-year-old female with a complaint of genital bleeding was referred to our hospital. In her past history, 4 times of transurethral resection of bladder tumor (TUR-BT) for bladder cancers and right nephroureterectomy with cuff for right ureteral tumors were performed during these 17 years, followed by simple cystectomy 3 years before. A punch biopsy of anterior vaginal wall demonstrated metastases of transitional cell carcinoma. Although total histero-vaginectomy was performed, recurrence of disease was observed in bone, skin and inguinal lymph nodes 9 months after the operation. This case is the 13th report of vaginal metastases of transitional cell carcinoma in the world.