膀胱癌肉腫の1例

Abstract

68歳男.主訴は無症候性肉眼的血尿, 冷汗, 全身倦怠感.術前診断T2aN0M0として腰椎麻酔下にTUR-Bt施行した.病理組織学的検査では腫瘍は約半量が壊死に陥っていたが移行上皮癌細胞と紡錘形肉腫の混在を認め, 癌肉腫, pT2aと診断された.又, 一部に大型多角形細胞が充実性増殖を示していた.移行上皮癌細胞は浸潤型でG3>G2であった.紡錘形細胞増殖部の免疫染色はDesmin, α-SMAは陰性で, Vimentinは陽性であった.S-100蛋白は紡錘形細胞に混じる少数の小数細胞において陽性であった.前立腺部尿道生検において癌肉腫の浸潤がないことが確認されたため膀胱全摘術及び回腸利用新膀胱造設術を施行した.全身状態良好にて退院したが, その後CTにて縦隔, 肺, 肝臓に転移を認め, 転移巣は急速に増大し, 全身状態悪化し死亡した

We report a case of carcinosarcoma of the urinary bladder. A 68-year-old man visited our hospital with complaints of asymptomatic macroscopic hematuria, cold sweat and general malaise. Excretory urography revealed a filling defect in the left wall of the bladder, and subsequent cystoscopy revealed a non-papillary sessile tumor. The tumor was transurethrally resected and its histology showed carcinosarcoma which was characteristics of a mixture of transitional cell carcinoma with spindle cell sarcoma. The patient underwent total cystectomy and his bladder was reconstructed with the ileum. Nevertheless, he died of multiple organ metastases 3 months after the surgery.