初診時より頸部リンパ節転移を認めた前立腺癌の2例

Abstract

症例1は56歳男.左下腹部痛を主訴に受診し, 直腸内指診で前立腺癌を疑われ入院した.生検の結果.頸部リンパ節が腺癌であったことから, 遠隔リンパ節転移を伴う前立腺癌stage D2と診断しホルモン療法を行った.その後, 前立腺部の腫脹の再燃による症状の悪化を認め, 更に残存腫瘍の再燃, 骨盤内占拠及び一部体表より突出し癌死した.経過中, PSAは正常化せず, ホルモン不応性に陥っていた.症例2は66歳男.左頸部腫瘤を主訴に受診し入院となった.頸部リンパ節生検により腺癌が疑われ, 左頸部腫瘤摘出術, 経会陰的前立腺針生検を行った.その結果, 進行性前立腺癌stage D2と診断した.両側精巣摘除術後ホルモン療法を開始し, 経過観察となった.治療開始後4ヵ月現在, 傍大動脈リンパ節を含め縮小傾向を認めるが, PSAは正常化していない

We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1, 700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.