診断困難であった前立腺乳頭状腺癌の1例

Abstract

9年前に前立腺肥大症に対し経尿道的前立腺切除術を受けた84歳男.血尿を主訴に受診したが, 直腸診所見やPSA値は正常範囲であった.約3年後, PSA値の上昇と共に血尿が増強した為膀胱尿道鏡を施行したところ, 前立腺部尿道に乳頭状腫瘍の密生を認め, 前立腺左葉芽前立腺肥大様に突出していた.X線検査でも前立腺部尿道に辺縁不整な陰影欠損を認めた.以上より, 後部尿道腫瘍及び前立腺肥大症と考えられ経尿道的切除術を施行した.術後の骨盤CTで左精嚢浸潤を認めたがリンパ節腫大はなく, 骨シンチも正常な為, 前立腺乳頭状腺癌T3N0M0と診断した.放射線治療を行い, 血尿の消失とPSA値の低下を認めた.PSA値の推移によってはホルモン療法の導入も検討している

We report a case of papillary adenocarcinoma of the prostate found by urethroscopy. An 84-year-old male visited our hospital complaining of initial hematuria in July 1997. No abnormal findings were detected despite repeated urological examinations until endoscopic examination revealed fine papillary tumors in the prostatic urethra along with benign prostatic hyperplasia-like prominent left lobe of the prostate in June 2000. Serum prostate specific antigen (PSA) level was 4.1 ng/ml. He underwent transurethral resection of the urethral tumors and the prominent lobe, which was found to contain packed papillary tumors. Both of these tumors were well differentiated papillary adenocarcinoma most likely originating from the prostate because PSA immunostaining was positive. The prostate was irradiated postoperatively. Papillary adenocarcinoma localized in the prostate is difficult to diagnose preoperatively.