多房性嚢胞形成をきたした前立腺導管癌の1例

Abstract

72歳男.主訴は夜間頻尿.経腹的前立腺超音波検査では前立腺に多房性嚢胞を認め, 嚢胞は一部充実性であった.尿道膀胱造影では, 前立腺部尿道は著明に延長, 扁平化し, 左側へ強く圧排されていた.胸腹部造影CTスキャンでは壁肥厚を伴う多房性前立腺嚢胞と右水腎症と右内腸骨リンパ節腫大を認めた.経直腸的超音波ガイド下に嚢胞内容液採取及び前立腺針生検を施行した.病理組織学的所見から, 膀胱と直腸へ浸潤し, 多房性嚢胞形成を伴った前立腺癌T4N1M0と診断し, Bicalutamide(Casodex)による内分泌療法を開始した.治療開始からPSAは緩徐に低下し, 治療開始5ヵ月にPSAは正常化し, MRIでも前立腺は著明に縮小し, 多房性嚢胞と右水腎症は消失した

A 72-year-old man was admitted to our department with the complaint of nocturia. PSA was elevated to 18.2 ng/ml. Transrectal ultrasonography, CT scan and MRI showed multilocular cystic lesions at the posterior site of the prostate, with rectal and bladder invasion and lymph node metastasis. Transrectal needle biopsy of the prostate and fluid aspiration of the prostatic cyst were performed. The aspirated fluid was bloody, but the result of cytology was negative. Histopathological examination of the needle biopsy specimen revealed ductal carcinoma of the prostate. We diagnosed this case as a T4N1M0 prostatic cancer, and started endocrine therapy. Thirty-nine cases of adenocarcinoma of the prostate with cystic formation in the Japanese literature are reviewed.