膀胱全摘除,尿道切除後17ヵ月目に尿道舟状窩に再発した膀胱癌の1例

Abstract

75歳男.患者は膀胱前壁を中心とした多発性乳頭状広基性腫瘍で, その内の1つは内尿道口に存在していた.膀胱癌T2aN0M0と診断し, M-VAC療法1コースが施行されたが, 術後14ヵ月目に外尿道口からの血性分泌物を自覚した.放置していたものの, 軟性膀胱鏡検査で尿道舟状窩に充満するように存在する多発性乳頭状腫瘍を認め, 膀胱癌の尿道舟状窩への再発と診断された.陰茎部分切除術を施行後, 合併症なく退院なったが, 腹部CTにて膵腫瘍を指摘され, 化学療法が施行された.膵尾部切除により病理組織学的所見ではtubular adenocarcinomaであり, 膀胱癌の膵転移は否定された.以後, 患者は膵癌の腹膜播種にて最終的に死亡となった

We report a case of bladder cancer recurrence in fossa navicularis of urethra 17 months after cystourethrectomy for bladder cancer. A 75-year-old man had undergone cystourethrectomy preserving between fossa navicularis and external meatus, and ileal conduit urinary diversion for advanced bladder cancer on June 24, 2002. Histopathological findings showed urothelial carcinoma, G2>G3, pT1N0. The patient had been followed regularly for 17 months without evidence of recurrence until he suffered the onset of hemorrhagic urethral discharge. Endoscopic examination of the residual urethra showed multiple, papillary sessile tumors which almost filled the fossa navicularis. He was admitted to our hospital on December 15, 2003. The urethral wash cytology revealed urothelial carcinoma. Since computed tomography, magnetic resonance imaging, and bone scintigraphy showed no evidence of lymph node and distant metastasis, partial penectomy was performed. Histopathological findings showed urothelial carcinoma pTa, G2>G3, which was identical to primary tumor. Tumor had not invaded the corpus cavernosum. Careful follow-up of the patients with preservation of fossa navicularis is important.