ヒト絨毛性ゴナドトロピン産生膀胱癌の1例

Abstract

症例は86歳男で, 肉眼的血尿を主訴とし, 膀胱鏡で頂部に径3～4cmの腫瘍を認めた.臨床的に病期T1以上と診断し, まず経尿道的膀胱切除術を施行した.病理組織診で筋層浸潤を示すpT2以上のgrade 3移行上皮癌に混在して合胞体細胞様巨細胞を認めた.β-HCG染色を施行したところ陽性であったためβ-HCG産生膀胱癌と診断した.追加療法として膀胱全摘術+多剤併用化学療法も考慮したが, 高齢であり重度の心不全も有していたことから侵襲の少ない膀胱部分切除術を選択した.術後の病理組織診上残存癌は認めなかったが, 肺転移をきたし, 術後約2ヵ月目に死亡した

An 86-year-old man consulted our hospital complaining of gross hematuria. Cystoscopy revealed a nodular broad-based cancer at the dome of the bladder. The patient was initially treated by transurethral resection of bladder tumor. Since histological examination showed grade 3 transitional cell carcinoma containing giant cells that were positive for beta-human chorionic gonadotropin (beta-HCG), we made a diagnosis of beta-HCG-producing bladder cancer. Because of his advanced age and poor general condition, the patient underwent partial cystectomy alone without adjuvant chemotherapy. One month later, a chest X-ray film revealed multiple lung metastases, and he developed paraplegia of the lower extremities suggesting spinal metastases. One month later, he was brought to our hospital with cardiopulmonary arrest. This is, to our best knowledge, the 22nd case report of beta-HCG-producing bladder cancer in Japan.