同時性食道癌,潜在性肺癌を重複した膀胱小細胞癌の1例

Abstract

症例は65歳男で, 肉眼的血尿及び右背部痛を主訴とした.排泄性腎盂造影では30分像で右腎盂に造影剤の排泄を認めず, 膀胱内に陰影欠損を認めた.CT及びMRIで膀胱右後壁に径3cmの腫瘍を認め, 筋層は全周性に消失し, 周囲脂肪組織への浸潤が疑われた.生検結果と併せてTCC, G3, pT3b, N0, M0と診断し, 化学療法を施行したが, 1クール終了後, 胸部CTで径1.5cmの気管前リンパ節腫大を認め, 生検で扁平上皮癌と診断した.原発巣検索における胃内視鏡で径2cmのBorrmann3型食道癌を認め, 放射線・化学療法を施行した.食道癌はCRとなったが, リンパ節はNCであった.膀胱癌に対しては放射線療法を行ったが評価はPDで, 以後急速に病態が悪化し, 入院5ヵ月後に死亡した.病理解剖で膀胱小細胞癌の多発転移を確認し, 原発性の潜在性肺癌も認めた

We present a case of triple primary cancers occurring synchronously in the urinary bladder, esophagus, and incidentally in the lung. A 65-year-old man with a chief complaint of gross hematuria was admitted to our hospital. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was transitional cell carcinoma of the urinary bladder and he underwent one course of neoadjuvant chemotherapy (M-VAC) with the preoperative diagnosis of T3bN0M0. After one course of chemotherapy, chest CT, lymph node biopsy and esophagoscopy revealed squamous cell carcinoma of the esophagus. He first underwent radiochemotherapy (total 70 Gy, CDDP 5 mg x 41, 5-FU 250 mg x 24) for esophageal cancer and achieved complete remission. Then, he underwent radiotherapy for a total of 60 Gy for bladder cancer. However, his general condition gradually became worse and he died from metastatic cancer. The autopsy proved that he died from multiple metastases of small cell carcinoma of the urinary bladder and incidentally squamous cell carcinoma of the lung was identified.