膀胱原発小細胞癌の1例

Abstract

74歳女性.患者は頻尿を主訴とした.尿細胞診はclass IIIで, 膀胱鏡にて右後壁から頂部に乳頭状有茎性腫瘍を認め, TUR-Btを施行した.病理組織診断はtransitional cell carcinoma(TCC)で, 術後THP-ADRの膀胱内注入を10回行った.しかし, 5ヵ月後の膀胱鏡で前回とほぼ同部位に非乳頭状広基性腫瘍を認め, 腫瘍マーカーのNSE, pro-GRP上昇が確認され, staging TUR-Btを施行した.病理組織学的に膀胱小細胞癌で, 右外腸骨リンパ節転移, 壁外浸潤の急速な進行を認めたため, 肺小細胞癌のプロトコールに準じた化学療法と放射線療法の併用治療を開始した.治療開始後1ヵ月で腫瘍マーカーは陰性化し, 画像上もCRが得られたが, 退院後14ヵ月目に傍大動脈リンパ節腫脹が出現し, 化学療法を再度行うも無効で, 退院後18ヵ月目に死亡となった.尚, 剖検では両肺の転移巣に高分化のTCCを認めた

We report a case of primary small cell carcinoma of the urinary bladder. A 74-year-old woman was referred to our hospital because of pollakiuria. Cystoscopy showed a papillary tumor. We operated transurethral resection of the bladder tumor (TUR-Bt). Histopathological finding was transitional cell carcinoma (TCC), grade3, pT1 containing pTis. About six months later, tumor recurred to the bladder. Pathologic diagnosis was TCC in part and most was small cell carcinoma. Pelvic magnetic resonance imaging revealed a huge mass lesion with extravesical extension in the urinary bladder, and computed tomography scan showed external iliac lympho node metastasis. The rapid rise of a tumor maker NSE and pro-GRP were remarkable. It was diagnosed as a rapid advance of small cell carcinoma. We performed pelvic radiotherapy, and chemotherapy using carboplatin (CBDCA) and etoposide (VP-16). However 14 months after it had left hospital, computed tomography showed paraaortic lympho node metastasis. The patient died due to rapidly progressive disease.