移行上皮癌小腸転移の2例

Abstract

症例1(87歳男性).患者は肉眼的血尿で受診となった.膀胱右側壁に腫瘍を認め, TUR-BTで膀胱癌(TCC, G2)と診断したが, 膀胱摘除術を拒否され, 1年3ヵ月後, 全身倦怠感, 食欲低下で入院となった.臨床症状および画像所見より消化管穿孔による腹膜炎, 敗血症と診断して開腹術を施行したところ, トライツ靱帯より300cm肛門側に穿孔を伴う狭窄を認め, 小腸部分切除を行なった.だが, この閉腹中に敗血症性ショックを生じ患者は最終的に死亡となった.尚, 狭窄部の粘膜下層, 筋層漿膜側に腫瘍細胞を認められたことから膀胱癌小腸転移と診断した.症例2(53歳男性).患者は肉眼的血尿で受診となった.CTでは膀胱右壁肥厚と右水腎症を認め, TUR-BTで膀胱癌(TCC, G2>3)と診断した.MEC療法2クール施行後, 膀胱全摘除術を行い, 術中小腸に結節性病変を認めて部分切除を行った.小腸腫瘍はTCC(Transitional cell carcinoma)であった.術後経過良好で退院となったが, 約7ヵ月後, 膀胱癌の多発転移にて死亡となった

Transitional cell carcinoma (TCC) frequently metastasizes to lymph nodes, liver, lungs and bone. However, metastasis to the gastrointestinal tract is rare. We report two cases of bladder tumor which metastasized to the ileum. According to the literature, these are the 7th and 8th cases in Japan. Case 1: A 87-year-old man had a history of bladder tumor (TCC, grade 3, pT2bN0M0) and has transurethral resection of bladder tumor (TUR-BT) three times. Two months after the last TUR-BT, he was admitted with ileus. As computed tomography (CT) showed abdominal free air, our diagnosis was perforation of gastrointestinal tract. The patient received an operation which resected partial ileum. We found the elastic hard tumor in the ileum on the perforated lesion, which showed metastatic TCC in the ileum pathologicaly. Case 2 : A 53-year-old man visited our hospital with gross hematuria. Cystoscopy showed a non-papillary broad based tumor in the right wall of the bladder. CT showed a bladder tumor invaded into the prostate (pT4aN1M0), we performed total cyctectomy and ileal conduit after neo-adjuvant chemotherapy. During the operation, we found the tumor (2 cm in diameter) in the small intestine which was metastasized of bladder tumor.