G-CSF, PTH-rP産生膀胱癌の1例

Abstract

68歳女.排尿痛と頻尿を主訴とした.近医にて膀胱炎として加療されるも改善せず紹介され, 膀胱鏡で腫瘍が認められた.明らかな骨盤内リンパ節転移や胸部, 腹部への遠隔転移は認められなかった.経尿道的膀胱腫瘍切除を行い, 組織学的に移行上皮癌, 3度, 筋層浸潤, 脈管浸潤が認められた.免疫染色により腫瘍細胞内にGranulocyte colony-stimulating factor(G-CSF)とParathyroid hormone-related proteinが認められた.術後も末梢白血球数が高値を持続し, 血清G-CSFは70pg/mlと高値を示していた.その後, 腫瘍の急速な増大と共に全身状態が悪化し, 死亡した.Granulocyte colony-stimulating factorとParathyroid hormone-related proteinの両方を同時に産生する悪性腫瘍は極めて稀であり, 調べた範囲では本邦3例目であった

A 68-year-old woman presented with urinary pain and frequency. Cystoscopy, intravenous pyelography and magnetic resonance imaging showed a huge bladder mass and hydronephrosis of the left kidney. Transurethral resection of bladder tumor (TUR-Bt) was done. Histopathological findings of TUR-biopsy was high grade transitional cell carcinoma. Post operatively, the laboratory examination showed marked leukocytosis with a maximum of 99, 600/mm3 in the peripheral blood and a high level of granulocyte colony stimulating factor (G-CSF), 70 pg/ml in the serum (normal: less than 9.8 pg/ml). Serum calcium level increased gradually and parathyroid hormone-related protein (PTH-rP) revealed high, 8.4 pMol/l (normal: less than 0.6 pMol/l). The tumor cells were positive for G-CSF and PTH-rP immunohistochemical staining. She died of the disease 46 days after the operation. This is the third case of G-CSF and PTH-rP producing bladder tumor in the literature.