膀胱尿道全摘術後10年目に鼠径部リンパ節転移をきたした膀胱癌の1例

Abstract

79歳男.約10年前に膀胱癌に対して膀胱全摘術, 舟状窩以外の尿道摘除術と回腸導管増設術を施行し, 追加治療は行わず経過観察となっていたが, CTで左鼠径部リンパ節腫大を指摘された.経過観察となったが, 増大傾向を認めたため膀胱癌術後左鼠径部リンパ節転移と診断し, 鼠径部リンパ節摘除術を施行した.術後は全身化学療法を希望せず経過観察となったが, 胸部X-P上で肺転移が指摘された.更に, 左鼠径部のリンパ節腫大が再発し, 摘出術を行ったが, 肺転移の増悪とリンパ節腫大の再発を認め, 化学療法は効果なく, 亀頭部先端の乳頭状腫瘤も指摘された.その後, 全身状態が徐々に悪化し, 呼吸不全で死亡した

A 79-year-old man had undergone radical cystourethrectomy for bladder carcinoma in January, 1989. Pathological report was Small cell carcinoma (SCC) >> transitional cell carcinoma (TCC), G2 > G3, pT4 (prostate), ew (-). Ten years later, follow-up computed tomography (CT) revealed swollen left inguinal lymph node in October 1998 and lymph node dissection was performed in January, 2000. The pathological report showed TCC, G2. Left inguinal lymph node metastases appeared again in January, 2001. Chest X-ray films showed multiple lung metastases in March, 2001. Three couses of MVAC (methotrexate, vinblastine, doxorubicin cisplatinum) chemotherapy had been performed since September, 2001 but were in effective. Papillary tumor was observed at external urethral meatus in September, 2002 and the biopsied specimens showed TCC, G1 > G2, pathologically. Finally he died of respiratory insufficiency in January, 2003. It is suggested that the recurrent TCC tumor in the urethral remnants might metastasize into the inguinal lymph nodes.