原発性膀胱絨毛癌の1例

Abstract

75歳男.主訴は肉眼的血尿と頻尿であった.膀胱鏡検査で膀胱内腔に凝血塊と壊死組織が付着する有茎性腫瘍を認めたため, TUR-Btを施行した.病理診断はTCC with choriocarcinoma matous differentiation, G3, ≧pT2であり, TCCの部分とこれらの腫瘍細胞から移行するような大型で核異型の著明な細胞がシート状に増殖していた.そこでHGC-β染色を行ったところ, 大型異型核を有する腫瘍細胞を主体に細胞質が強く陽性を示した.以上から, 浸潤性膀胱絨毛癌と診断し, 膀胱全摘+回腸導管造設術を施行した.摘出標本の病理組織学的診断の結果, TCC, G3, pTisの上皮内癌を認めた.術後3ヵ月半にHCG-βの上昇を認め, 左肺舌区に腫瘍陰影を認め膀胱癌の肺転移と診断し, シスプラチン, エトポシドによる化学療法を施行した.その後, HCG-βは一時低下したが, 左肺の腫瘍が増大し, 膀胱全摘術後8ヵ月で死亡した.剖検で膀胱絨毛癌の転移は両肺, 肝, 両腎, 胃, 膵, 甲状腺, 両副腎, 心, 空腸, 椎体とリンパ節では両肺門, 縦隔, 右顎下腺近傍に認めた

A 75-year-old man visited our hospital presenting with gross hematuria. Cystoscopy revealed a bladder tumor with coagulated blood and necrotic tissue at the dome. We resected the bladder tumor transurethrally. Pathologically, the tumor was shown to be a transitional cell carcinoma with choriocarcinomatous differentiation, G3, > or = pT2. Immunohistochemical staining showed human chorionic gonadotropin (HCG)-positive tumor cells. Just after surgery, the serum HCG-beta concentration was less than 0.1 ng/ml. Total cystectomy and an ileal conduit operation were performed. The histological classification was TCC, G3, pTis. In later blood chemistry tests, HCG-beta elevation was observed. Pulmonary metastases appeared on a chest X-ray, and combination chemotherapy with cisplatin and etoposide was administered. Although the serum HCG-beta decreased with one course of chemotherapy, it increased immediately thereafter. The patient died of the disease about 8 months after the total cystectomy. Autopsy revealed multiple metastases in the lungs, liver, kidneys, stomach, pancreas, thyroid gland, adrenal glands, heart, jejunum, and vertebral body (Th10). Lymph node metastases in the pulmonary hilum, mediastinum, and right submaxillary gland were also found.