長期経過観察しえた尿膜管癌5例の臨床的検討

Abstract

1)Sheldonらの分類でstage IIIA迄の尿膜管癌の初回手術として, 臍・尿膜管全摘除術を加えた膀胱部分切除術にて長期の生存, 膀胱温存が得られる可能性が示唆された.2)CEAは患者血清4例中2例, 尿膜管癌組織5例中5例で陽性であり, 尿膜管癌の腫瘍マーカーとなる可能性が示唆された.3)p53は尿膜管癌組織5例中4例で陽性であったが, stageや予後との相関は認められなかった

Five cases of urachal carcinoma experienced in our hospital during the past 20 years are reported. Surgical resection is considered as the first treatment option of this disease, and other therapies to be less beneficial. Complete surgical extirpation and detection of recurrence in the early stage are considered to be important since local recurrence occurs frequently. We enforced the bladder preserving operation for 4 patients with urachal carcinoma except for 1 case with peritonitis carcinomatosa in the initial diagnosis, and multiple surgical treatment was performed again for 2 patients with recurrence. The bladder was preserved with no evidence of malignancy in three patients for 24, 19 and 5 years, respectively. In the initial management of urachal carcinoma, we believe that bladder-preserving surgery should be considered in selected cases though close follow-up is demanded. Herein, we also report the immunohistochemical study of paraffin-embedded specimens using anti-CEA, CA19-9, CA125 and p53 monoclonal antibodies. The positive reaction was observed in 100% (5/5) for CEA, 80% (4/5) for CA19-9, and 20% (1/5) for CA125. These results suggest that CEA may be a useful marker in the diagnosis of this neoplasm and early detection of its recurrence. Nuclear accumulation of p53 was observed in 80% (4/5), but it did not correlate with the disease progression.