膀胱上皮内癌に対するBCG膀胱内注入療法後に発症した前立腺部移行上皮癌の3症例

Abstract

症例1:70歳男.健診で尿潜血を指摘され, 膀胱上皮内癌(CIS)と診断された.治療後に尿細胞診は一旦陰性化したが, 再度陽性化した.前立腺腺管内にTCC(G2)を認め, 膀胱尿道全摘術および回腸導管造設術を施行した.術後経過は良好で再発はない.症例2:74歳男.糖尿病内科検診で左腎に嚢胞性病変を認め紹介された.腹部CTで腎嚢胞と診断し, 膀胱ランダム生検を施行し膀胱CISと診断した.膀胱尿道全摘術を施行し, 尿管を追加切除し両側尿管皮膚瘻造設術を行った.病理組織検査で前立腺内の腺管内を中心にTCCを認め, 一部では間質へ浸潤している部位を認めた.術後, 右上部尿路に尿細胞診陽性を認めたためBCG腎盂内注入療法を施行し, 両側の腎盂尿とも尿細胞診は陰性化した.症例3:50歳男.右精巣腫瘍で右精巣高位摘出手術および化学療法施行既往があった.今回, 血尿を認め, 前立腺TUR生検により前立腺管内にTCCを認めた.根治的膀胱全摘術を施行し, 回腸新膀胱造設術を施行した.術後経過は良好で転移再発を認めていない

We report 3 cases of prostatic involvement of transitional cell carcinomas (TCCs). All cases presented positive urinary cytology after intravesical instillation of Bacillus Calmette-Guerin (BCG) and then random biopsy of bladder and transurethral resection (TUR)-biopsy of prostatic urethra were performed. TUR-biopsy demonstrated TCC in the prostate, although random biopsy failed to detect tumors in the bladder in all cases. Case 1 was treated with cystourethrectomy with ileal conduit, case 2 was treated with cystourethrectomy with bilateral ureterocutaneostomy and case 3 was treated with cystectomy with orthotopic ileal neobladder reconstruction. All cases are alive with no evidence of disease. TUR-biopsy of prostatic urethra should be perfomed when patients present positive urinary cytology after BCG instillation therapy, because prostatic involvement of TCC associated with bladder carcinoma in situ is not rare.