シスプラチンによる術前動注療法にて組織学的に著効が得られた膀胱原発神経内分泌癌の1例

Abstract

68歳男.シスプラチン150mgの動注によって腫瘍は著明に縮小し, MRI上の縮小率は65%であった.病理学的にも腫瘍は完全に壊死に陥っており, 術後12ヵ月の現在, 再発は認めていない

A 68-year-old male was admitted to our hospital with a complaint of asymptomatic gross hematuria. On physical examination, a huge mass was palpable in the lower abdomen. Computed tomography revealed a huge mass, 12 x 10 cm in size, in the urinary bladder and no metastatic lesions. The value of serum neuron specific enolase (NSE) was 32 ng/ml (normal range: 0-10 ng/ml). Histopathological and histochemical studies revealed neuroendocrine carcinoma which was positive for NSE, chromogranin A, S-100 and cytokeratin. He underwent neoadjuvant ballon occluded arterial infusion (BOAI) chemotherapy with cisplatin (CDDP). Total cystectomy and ileal conduit formation were performed at the preoperative diagnosis of T3N0M0. Examination of the resected specimen indicated a pathologically complete response and he was discharged. The patient is still alive with no evidence of any recurrence at 3 months after the operation. This case suggests that treatment with combined total cystectomy and neoadjuvant BOAI chemotherapy is effective against neuroendocrine carcinoma of the urinary bladder.