尿道直腸ろうを合併した原発性前立腺扁平上皮癌の1例

Abstract

61歳男.主訴は排尿困難と発熱であった.膿尿, 細菌尿を認め, 急性前立腺炎と診断し入院した.抗菌剤を投与したところ解熱し膿尿は消失したが, 排尿困難は残存した.経直腸的前立腺針生検により扁平上皮癌と診断された.画像所見では, 前部尿道の狭窄と膀胱底部の挙上が認められ, 腫大した前立腺は精嚢腺及び直腸と連続し, 浸潤が疑われた.直腸浸潤を伴う原発性前立腺扁平上皮癌と診断し, 化学療法で腫瘍の17%の縮小の後, 膀胱前立腺直腸摘除術及び回腸導管造設術を施行した.術後, 骨盤部に60Gyのliniac照射を施行した.術後12ヵ月の現在, 腫瘍の再発は無い.又, 術前高値であった血中扁平上皮癌抗原は正常化している

Eleven cases of squamous cell carcinoma of the prostate have been previously reported in the Japanese medical literature. Patients with this type of carcinoma have dismal prognoses. Herein, we report a case in a 61-year-old man who was admitted to our hospital and whose chief complaints were dysuria and high fever. Pyuria, bacteriuria, and the results of a digital rectal examination suggested acute prostatitis. Despite the administration of antibiotics, the dysuria did not improve. A transrectal needle biopsy was performed, and histology of the tissue showed squamous cell carcinoma. After chemotherapy using methotrexate, pirarubicin, and cisplatin, total pelvic excentration was performed. At 12 months after the operation, the patient is alive with no evidence of the disease.