両側上部尿路膀胱上皮内癌に対してBCG注入療法施行後に発生した腎盂扁平上皮癌の1例

Abstract

73歳男.1993年より膀胱移行上皮癌に塩酸エピルビシン30mgの膀胱内注入療法を施行され, 1995年に両側上部尿路及び膀胱の上皮内癌と診断された.DJカテーテルを用い膀胱尿管逆流を誘発し上部尿路にBacillus Calmette-Guerin(BCG)を灌流する方針としたが, 一側の灌流を行った際, BCGによると思われる発熱, 腎機能障害などの副作用が出現したため投与量を漸減し, 反対側に関しては投与を中断した.2000年4月頃より発熱が持続し貧血の進行も強度であったため精査となり, 左膿腎症及び左腎盂腫瘍の診断で左腎尿管摘除術を施行した.病理組織学的所見から, 角化, 線維化, 炎症細胞浸潤を高度に伴った腎盂扁平上皮癌で腎実質への浸潤を認めた.術後18ヵ月で経過観察中である

A 73-year-old man was admitted with high fever. Histopathologically, he was diagnosed with transitional cell carcinoma in situ (CIS) of bilateral upper urinary tracts and urinary bladder in April, 1995. Double J shape ureteral catheter was placed in the left ureter to induce vesicoureteral reflux and Bacillus Calmette-Guerin (BCG) was instilled intravesically every week. Then, the same procedure was performed on the other side. Unfortunately, the treatments could not be completed due to severe complications (high fever and renal dysfunction). Follow-up studies revealed that the left kidney had lost function and right upper urinary tract still had CIS. Therefore, right nephroureterectomy was performed for right renal pelvic cancer (TCC, G3, pT1) followed by permanent hemodialysis in September, 1996. Invasive bladder cancer arose in the abandoned bladder and cystourethrectomy and left ureterocutaneostomy was performed in September, 1999. In April 2000, imaging studies revealed a renal pelvic tumor in his left kidney and left nephroureterectomy was performed. Histopathological diagnosis was squamous cell carcinoma of the left renal pelvis.