前立腺小細胞癌の1例

Abstract

症例は81歳男性.頻尿を自覚し, 近医泌尿器科を受診した.前立腺の腫大を指摘された.精査加療目的で入院した.CTで前立腺の辺縁は不正であり内部は不均一に造影された.また傍大動脈周囲リンパ節の腫大を認め, 骨シンチグラフィにて胸椎, 腰椎, 骨盤に多発性の骨転移を認めた.以上より前立腺中分化型腺癌, stage D2と診断し, 内分泌療法として酢酸リュープロレリン投与を開始した.退院後, 再燃し様々な内服治療を試みたが血清PSA値は徐々に上昇した.化学療法の施行を前に, 肝機能への負担を軽減する目的で酢酸リュープロレリンを中止し外科的去勢術を施行した.その後, 血清PSA値は急激に上昇し, 腫瘍の増大による両側水腎症, 腎後性腎不全, 単純性イレウスを発症し入院した.右腎瘻造設術, 人工肛門造設術を施行したが全身状態が徐々に悪化して死亡した

A 81-year-old man was admitted to our department with the chief complaints of pollakisuria and difficulty in voiding. He presented with increased serum PSA level (over 100 ng/ml). We performed biopsy of the prostate and found a moderately differentiated adenocarcinoma. Various urological examinations showed metastases to paraaortic lymph nodes and systemic bones. He was started-on hormonal therapy. Nine months from the start of hormonal therapy, this therapy was effective and the serum PSA level was decreased to 14 ng/ml. Thereafter, the serum PSA level and the tumor volume were increased and he died 29 months from the start of treatment. The autopsy revealed small cell carcinoma with adenocarcinoma of the prostate.