血清CA19-9が高値を呈した膀胱原発Paragangliomaの1例

Abstract

症例は44歳女性で, 下腹部痛を主訴とし子宮筋腫の精査中に膀胱腫瘍を発見された.CA19-9が高値を示し, CTとMRIで膀胱後壁に嚢胞状腫瘤を認め, 生検時に発作を呈し過去に排尿時発作を経験していたことが確認できた.血中尿中カテコラミンは正常であったが, 腫瘍内容液中カテコラミンが異常高値を示した.以上より本病と診断し, 膀胱部分切除術を施行した.CA19-9染色では腫瘍部陰性であったが腫瘍周囲の粘膜層で散在性に陽性を示した.術後経過は良好で血清CA19-9は術後28日目に正常域まで下降した

A case of primary paraganglioma of the urinary bladder with a high serum CA19-9 level is reported. A 44-year-old woman visited our hospital with the chief complaint of lower abdominal pain. Magnetic resonance imaging (MRI) examination incidentally revealed a cystic bladder tumor. Cystoscopy disclosed a broad-based non-papillary tumor on the posterior wall of the urinary bladder. With the diagnosis of a bladder submucosal cystic tumor transurethral needle puncture and biopsy were performed. The solution sampled with puncture was bloody. The patient suddenly complained of headache and blood pressure was elevated to 215/120 mmHg when we held the tumor with a cold cup biopsy forceps. Catecholamine levels of the solution in the tumor were abnormally elevated. The serum CA19-9 level was also raised. Ten days later, she underwent partial cystectomy. Histological findings of the removed specimen showed primary paraganglioma of the urinary bladder. The serum CA19-9 level decreased to normal limits on the 28th postoperative day. Our experience suggests that the level of serum CA19-9 may serve as a useful index for observing the clinical course of a patient with this disease.