同時に発見された泌尿器系三重複癌(腎癌・膀胱癌・前立腺癌)の1例

Abstract

72歳男.無症候性肉眼的血尿を自覚したため受診し, 直腸診で鶏卵大, 弾性硬の前立腺を触知し, 表面平滑で圧痛, 硬結は認めず, 表在リンパ節も触知しなかった.腫瘍マーカーのうちPSAのみが高値で, 尿沈渣で極度の血尿と軽度の膿尿を認めた.膀胱鏡で膀胱三角部後方に有茎性, 乳頭状の腫瘍と凝血塊突出を認めた.DIPでは左中下腎杯の圧排と陰影欠損を, ダイナミックCTで左腎中部から下極に腫瘤を認めた.左腎腫瘍, 膀胱腫瘍と診断し, 前立腺癌を疑った.全身麻酔下, 左腎尿管摘出術, 腎門部リンパ節郭清, 経尿道的膀胱腫瘍切除術, 経会陰的前立腺針生検を施行した.病理組織学的所見より泌尿器同時性三重複癌(腎細胞癌・膀胱移行上皮癌・前立腺癌)と診断した

A case of synchronous triple urogenital cancer, which was comprised of renal cell carcinoma of the left kidney, transitional cell carcinoma of the urinary bladder, and adenocarcinoma of the prostate, is reported. A 72-year-old Japanese male patient was referred to our outpatient clinic with the complaint of asymptomatic hematuria. At that time, his serum of level of PSA was elevated to 20 ng/ml. Cystourethroscopy showed a papillary bladder tumor and coagula through the left urinary orifice. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass lesion measuring about 6 cm by 5 cm in the left kidney. Angiography showed a hypervascular lesion measuring about 6 cm by 5 cm at the same site. Double cancer, consisting of renal cell carcinoma and transitional cell carcinoma of the urinary bladder, was suspected and we performed left total nephroureterectomy, hilar lymphadenectomy, and transurethral rection of the bladder tumor, one month later. At the same time, we performed a biopsy of the prostate. Histological diagnosis was renal cell carcinoma, clear cell carcinoma and transitional cell carcinoma of urinary bladder. Histological diagnosis of the prostate biopsy was moderately differentiated adenocarcinoma. Since this case fulfilled the criteria of Warren and Gates, it was classified as synchronous triple urogenital cancer. A review of the literature revealed 17 authentic cases of triple urogenital cancer, of which 14 and 10 cases were reported as a combination of renal cancer, bladder cancer and prostatic cancer, in the world and in Japan, respectively. Furthermore, he had been exposed to the atomic bomb explosion in Hiroshima in 1945. This carcinogenic precursor may be related to the development of the triple cancer.