G-CSF産生膀胱腫瘍の2例

Abstract

症例1は79歳女.右側の水腎症により発見された.大部分が扁平上皮癌, 一部が移行上皮であった.骨盤壁への浸潤のため外科的治療は行わず, 7ヵ月後に死亡した.白血球数は経過中に76200/mm3まで上昇し, 腫瘍組織の免疫組織学的検討によりG-CSFが高濃度に含まれていることが示された.症例2は80歳男.膀胱癌診断時に手術を拒否し, 2年後に尿管皮膚瘻を造設した.49500/mm3の白血球数増加が認められ, 放射線照射により一時的に減少した.放射線治療中及び治療後の血清G-CSF値はそれぞれ54pg/ml, ≦30pg/mlであった.免疫組織学的にG-CSFが腫瘍内に認められた.10ヵ月後に死亡した

Two cases of bladder tumor producing granulocyte colony-stimulating factor (G-CSF) are reported. The first case was in a 79-year-old female patient. A large bladder tumor was diagnosed as right-sided hydronephrosis. The tumor consisted mostly of squamous cell carcinoma with a few transitional cells. Total cystectomy could not be performed because of direct invasion by the tumor into the pelvis. The patient died without aggressive treatment about 7 months after admission. Her leukocyte count consistently increased up to 76, 200/mm3. The serum G-CSF levels were not analyzed. However, immunohistochemical examination revealed a high concentration of G-CSF in the tumor specimen. The other case was in an 80-year-old male patient. The patient, who had refused total cystectomy for bladder tumor (transitional cell carcinoma, grade 2, T2N0M0) 2 years earlier, underwent ureterocutaneostomy for obstructive renal insufficiency. Total cystectomy was not performed at this admission because of tumor invasion into the rectum and his advanced age. Radiotherapy was administered. However, he developed ileus caused by direct tumor invasion into the ileum. He died about 10 months after the urinary diversion. Leukocytosis, which improved transiently following radiotherapy, became more severe. The maximum leukocyte count was 49, 500/mm3 just before death. The serum G-CSF levels during and after radiotherapy were 54 pg/ml and < 30 pg/ml, respectively. Immunohistochemical examination revealed the presence of G-CSF in the tumor. These findings suggest the production of G-CSF by the bladder tumor.