A case of quadruple cancer including urinary bladder, oral cavity, stomach and lung

Abstract

67歳男性.患者は1998年12月に口腔底に発生した高分化型扁平上皮癌に対して, 放射線療法後(40Gy, 17回), 外科的治療を受けた(pT2, pN2b, M0).その際, 全身検索において胃に高分化型腺癌を発見されたため, 胃亜全摘出術を施行した(pT2, pN0, M0, P0, CY0).更に2004年4月にフォローの胸部CT検査において左肺上葉に孤在性の低分化型腺癌が発見され, 肺部分切除術を施行された(pT1, N0, M0, P0, Br-).以後, 経過を観察されていたが, 2000年11月に膀胱から後部尿道にかけての尿路上皮癌の再発を認めたため, 根治的膀胱全摘術ならびに両側尿管皮膚瘻作成術を施行した(pT4a, pN2, M0, pL2, pV0, pR0)

A 67-year-old man, who had smoked heavily for many years, was found in 1997 to have bladder tumors, and transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopathological diagnosis was urothelial carcinoma (G2>G3, pTa, N0, M0, ly0, v0). In December, 1998, he noticed an oral cavity tumor. After preoperative radiation therapy (total 40 Gy, 17 times), surgical treatment was undertaken. Histopathological diagnosis was well differentiated squamous cell carcinoma (pT2, pN2b, M0). In February, 2000, gastric tumor was detected by endoscopic examination, and subtotal gastorectomy and Roux en Y operation were performed. Histopathological diagnosis was well differentiated adenocarcinoma (pT2, pN0, M0, P0, CY0). A chest computed tomographic (CT) scan revealed a solitary lung tumor in April, 2000. Partial peumonectomy was performed, and histopathological diagnosis was poorly differentiated adenocarcinoma (pT1, N0, M0, P0). In April, 2000, multiple lesions of bladder cancer in the neck of the urinary bladder and posterior urethra were found and radical cystoprostatourethrectomy combined with lymph node dissection and bilateral cutaneous ureterostomy were performed (urothelial carcinoma, G3, pT4a, pN2, M0, pL2, pV0, pR0). Since then, the patient has been followed carefully.