Malignant pheochromocytoma of the urinary bladder

Abstract

54歳女性.患者は超音波検査にて膀胱に異常腫瘤を指摘され, 著者らの泌尿器科へ受診となった.膀胱鏡検査では膀胱後壁に小指頭大の非乳頭状広基性腫瘍が確認され, 経尿道的膀胱腫瘍切除術を施行となった.しかし, 切除開始時, 収縮期血圧が240mmHgまで急激に上昇し, 切除続行は困難と判断し手術を中止に, することとなった.術後は血清ノルアドレナリン濃度の上昇がみられた.病理組織学的診断では悪性褐色細胞腫であった.その後, 膀胱部分切除術および骨盤内リンパ節郭清術を施行したところ術後1年経過現在, 再発の徴候は認められていない

A case of malignant pheochromocytoma of the urinary bladder is presented. A 54-year-old woman visited our hospital for screening and was found to have an abnormal mass in the bladder on ultrasonography. The patient was not hypertensive. Cystoscopy revealed a broad-based, small fingertip-sized, nonpapillary tumor on the posterior wall of the urinary bladder. Transurethral resection (TUR) was performed without suspicion of pheochromocytoma because of her well-controlled blood pressure and lack of characteristic symptoms. Transient elevation of systolic blood pressure to 240 mmHg occurred during resection of the tumor. Radical resection was therefore not possible. The serum norepinephrine level was elevated postoperatively. Pathologic examination revealed a malignant pheochromocytoma. On January 30, 2003, partial cystectomy of the residual tumor and pelvic lymphadenectomy were performed. She has had no clinical sign of recurrence for 1 year after the second operation.