前立腺乳頭状腺癌の3例

Abstract

症例1:74歳男.顕微鏡的血尿を主訴とした.膀胱尿道鏡検査にて膀胱後三角部および前立腺部尿道にそれぞれ単発性の乳頭状有茎性腫瘍を認め, 多発性移行上皮癌の疑いでTUR-Btを施行した.病理組織学的に乳頭状腺癌と診断した.症例2:71歳男.肉眼的血尿を主訴とし, 尿道鏡検査にて前立腺部尿道精丘付近に乳頭状腫瘍を認めた.TUR-Pを施行し, 病理組織学的に乳頭状腺癌と診断した.症例3:68歳男.頻尿と排尿困難を主訴とし, 血清PSA高値と画像所見より前立腺部尿道周囲癌を疑い, TUR-Pを施行した.病理診断は乳頭状腺癌で, 前立腺全摘術と回腸導管造設術を施行した.全例再発を認めていない

We report here 3 cases of papillary adenocarcinoma of the prostate. In all 3 cases, the tumors were discernible on cystourethroscopy and transurethral biopsy established the diagnosis, whereas no significant finding was found on digital rectal examination. Although androgen deprivation therapy was administered in all cases, different surgical procedures were employed according to the stage in each case. In case 1, since the papillary tumor was confined within the prostatic urethra, complete resection was accomplished by transurethral resection (TUR). In case 2, since pelvic lymph nodes metastases were found, local radiation therapy was added. In case 3, since the patient had vesical invasion of tumor total cysto-prostatectomy was performed. Papillary adenocarcinoma of the prostate originates from the prostatic duct, resulting in existence at the "central portion" of the prostate gland. Cystourethroscopy and transurethral biopsy is helpful for diagnosis of this disease, whereas rectal digital examination is useless. As a surgical procedure for the primary site, TUR may be efficient for tumors confined within the prostatic urethra, although more extensive surgery may be necessary for those with a more invasive profile.