膀胱原発小細胞癌の1例

Abstract

60歳男.顕微鏡的血尿の精査を行ったところ, 膀胱部に陰影欠損を, 膀胱鏡では表面に石灰化を伴った広基性乳頭状腫瘍を認めた.経尿道的膀胱腫瘍切除術を施行し, 経過観察となった.その後, 血尿が出現し, 膀胱鏡ではほぼ膀胱全腔を占める非乳頭状の広基性乳頭状腫瘍を, 骨盤部CTでは膀胱壁外浸潤を認めた.経尿道的膀胱腫瘍切除術及び凝固術を施行したが, 肉眼的血尿を繰り返す為膀胱摘除術ならびに両側の尿管皮膚瘻術を施行した.腫瘍が骨盤内に強固に癒着しており, 根治性は期待できなかった.術後は, 放射線療法と化学療法を行ったが, 広範囲の後腹膜リンパ節転移, 肝及び肺転移をきたし死亡した

We report a case of small cell carcinoma of the urinary bladder. A 60-year-old man with microscopic hematuria was referred to our hospital. Cystoscopy revealed a sessile tumor on the left lateral wall of the urinary bladder. The patient underwent transurethral resection of the bladder tumor (TUR-Bt). Because of muscle invasion (pT2), total cystectomy was recommended, but was not performed because the patient would not give consent for the operation. Six months after TUR-Bt, invasive bladder tumor recurred and total cystectomy was performed. Pathological examination of the operative specimen revealed small cell carcinoma. Adjuvant combined therapy of irradiation and chemotherapy (nedaplatin and etoposide) was ineffective. Metastases to retroperitoneal lymph nodes, lung and liver were detected soon after the adjuvant therapy. The patient died 15 months after his first visit to our hospital.