尿細胞診陽性の子宮体癌の1例

Abstract

76歳女.1年前に肉眼的血尿を認め, 尿細胞診がclass IVで移行上皮細胞癌を疑われたが, 排泄性腎盂造影, 膀胱鏡, 膀胱生検で異常を認めなかった.その後も尿細胞診はclass IV～Vが続き, 頸部リンパ節腫脹が出現した.尿細胞診所見はN/C比増大, 核クロマチン増量, 核の大小不同, 比較的小型の異型上皮性細胞の集塊を認めたが, 背景は比較的きれいで, 壊死組織等の混入はなかった.腹部造影CTで子宮体部に不均一像を認め, 大動脈周囲リンパ節の腫脹も認めた.子宮内膜生検では一部充実性増殖を伴う類内膜腺癌を認め, 子宮頸部, 膀胱, 頸部リンパ節にも転移を認めた.子宮体癌で病期はclass IVと進行した状態であり, 患者・家族と相談の上, 積極的治療は行わず, 4ヵ月後に死亡した

A 76-year-old woman was admitted with a chief complaint of gross hematuria. Although no abnormality was found on excretory pyelography, class IV transitional cell carcinoma was suspected based on urinary cytology. However, no malignancy was observed on cystoscopy or on biopsy of the mucosa of the urinary bladder. Thereafter, class IV or class V carcinoma was continuously found by urinary cytology, and cervical lymphadenopathy was also observed. Since computed tomography showed the uterus enhanced heterogenously, the possibility of a gynecological tumor was considered. Poorly differentiated endometrioid adenocarcinoma was found on histological examination of the endometrium, and similar adenocarcinoma was also found on biopsy of cervical lymph node. Furthermore, infiltration of adenocarcinoma into the proper lamina of urinary bladder was found. These findings suggested that this tumor originated in the uterine body, followed by lymph node metastasis and infiltration into the urinary bladder. Concerning the route of emergence of carcinoma cells in urine, joining in urine via vagina seemed most likely. When malignant cells are found in urine, tumors of the urinary system should primarily be suspected, but at the same time, the possibility of a gynecological tumor should be kept in mind.