膀胱全摘除術後11年目に発生した腎盂腺癌・尿管移行上皮癌の1例

Abstract

52歳男.残尿感出現し, その後排尿終末時痛も出現したため当科受診した.後壁の粘膜は粗造で一部浮腫状に見え, TUR-biopsyを施行したところ右側壁及び前壁に上皮内癌(CIS)を認めた.以上より, 膀胱移行上皮癌Tis N0 M0と診断し, 膀胱前摘除術, 回腸導管造設術を施行した.その後外来にて経過観察となっていたが, 10年後下肢の浮腫が出現し, 腎盂腫瘍或いは腎細胞癌を疑い, 右腎尿管全摘除術を施行した.1年後再び血清LDHが上昇し再入院となり, 癌性悪液質のため死亡した

We report a case of upper urinary tract carcinoma which recurred 11 years after total cystectomy. A 52-year-old man presented with complaints of a sense of residual urine and terminal miction pain. Urinary cytology, cystoscopic examination and intravenous pyelography revealed normal findings. Twenty months later, because class V urinary cytologic findings were detected, transurethral biopsy was performed. Carcinoma in situ was diagnosed pathologically. Therefore, total cystectomy and ileal conduit urinary diversion were performed. The pathological diagnosis was transitional cell carcinoma, grade 3, pTis. At 127 months postoperatively, laboratory examination revealed an extremely high serum level of LDH (3, 084 U/l). The right kidney was not visualized on IVP and computed tomography revealed a right renal irregular mass. On the suspicion of a renal pelvic tumor, right total nephroureterectomy was done. The pathologic diagnosis was renal pelvic adenocarcinoma and ureteral transitional cell carcinoma. The patient was treated postoperatively with 3 cycles of systemic chemotherapy and radiotherapy. The serum level of LDH returned to normal. However, one year later, the serum level of LDH elevated to 1, 118 U/l. He died of retroperitoneal lymph node, left adrenal gland and pulmonary metastases.