G-CSF産生膀胱扁平上皮癌の1例

Abstract

55歳女性.患者は約4年5ヵ月前に肉眼的血尿で受診し, 膀胱腫瘍と診断されたが以後来院せず, 今回, 頻尿・排尿困難から慢性尿閉となり再受診となった.静脈性腎盂造影では膀胱内に陰影欠損を認め, CTでは膀胱左壁より内腔に突出した不均一に造影される8×6cm大の腫瘤を認めた.MRIではCT同様の腫瘤を認め, 膀胱筋層は腫瘍基底部で途切れるが, 膀胱外縁に不整は認めなかった.CRPは正常範囲内で, 白血球数増加からG-CSF産生腫瘍を疑い, 血中G-CSFを測定し77pg/mlと高値であった.経尿道的膀胱生検で, 疣状癌を含む高分化扁平上皮癌(SCC)と診断し, 膀胱全摘除術(子宮・卵巣合併切除)及び回腸導管造設術を施行したところ, 病理所見はSCCであった.術後経過は良好で白血球数は改善し, G-CSFも10pg/ml以下となった.以後10ヵ月経過現在, 再発は認められていない

A case of bladder squamous cell cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 55-year-old female presented with macroscopic hematuria and urinary frequency. Cystoscopy demonstrated a large bladder tumor. Computerized tomography and magnetic resonance imaging of abdomen and pelvis showed bladder muscular invasion, but did not reveal any metastasis. Laboratory examination showed leukocytosis of 23, 600/mm3 and a high value of granulocyte colony-stimulating factor (G-CSF) 77 pg/ml in the peripheral blood. She was diagnosed with bladder tumor 52 months ago, but did not seek further medical attention. The leukocyte count at that point was 10, 700/mm3. Radical cystectomy was performed. The histopathological diagnosis was well differentiated squamous cell carcinoma. Immunohistochemical examination was positive for G-CSF. After surgery the leukocyte count and value of G-CSF in the peripheral blood decreased to the normal range. There has been no recurrence of cancer for 10 months after surgery without any adjuvant therapy.