膀胱全摘後14ヵ月目に顕微鏡的肺腫瘍塞栓症にて死亡した1例

Abstract

70歳男.14ヵ月前, 尿管上皮癌に対し右腎盂尿管全摘術を施行していた.主訴は呼吸困難と軽度発熱で, 入院2日後突然呼吸困難が出現しショック状態となった.ICUで人工心肺による管理となった.心電図, 心エコー所見や肺動脈圧が65/30mmHGと著明に上昇し, 肺梗塞および肺高血圧症, 右心不全の所見を認めるが, 胸部造影CT, 心臓カテーテル検査, 肺動脈造影では肺に明らかな異常所見は認められなかった.症例の全身状態は悪化し, ICU入室6日目に死亡した.剖検により肺の組織から, 多くの肺動脈末梢および毛細血管内に腫瘍塞栓を認め, 肺高血圧症の直接の原因と考えられた.肺動脈内の腫瘍細胞は膀胱全摘時の膀胱腫瘍に類似しており, 腫瘍塞栓は尿路上皮癌由来と考えられた

A 70-year-old man was admitted with slight dyspnea and fever up. The patient had had total cystectomy for urothelial carcinoma of urinary bladder 14 months earlier and had a ureterocutaneostomy. At 2 days after the admission, he had a sudden attack of dyspnea. He was transferred to the intensive care unit, and mechanical ventilation was initiated. The pulmonary arterial pressure was measured at 65/30 mmHg, but the etiology for the pulmonary hypertension was unclear. Although highly suggestive of pulmonary embolism, chest roentgenogram and chest computed tomography (CT) showed clear lung fields. Pulmonary angiography disclosed no evidence of embolism. Despite anticoagulation therapy he died of respiratory failure. Autopsy revealed diffuse microscopic pulmonary tumor embolism with urothelial cacinoma in the pulmonary arterial vasculature. Microscopic pulmonary tumor embolism has rarely been reported with urothelial carcinoma.