膀胱Inverted papillomaの3例

Abstract

19歳男(症例1).頻尿, 血尿, 排尿時痛が出現し, 膀胱鏡で膀胱頸部11時に小指頭大の有茎性腫瘍を認め, TUR-Btを施行した.病理所見で腫瘍の表面は軽度過形成に伴う移行上皮で覆われ, その下方に充実性の胞巣を伴う移行上皮の増生を認めた.腫瘍の一部に軽度異型性を認めたため膀注化学療法を追加し, 術後10年で再発はない.63歳男(症例2).循環器科入院中に膀胱内腫瘤を指摘された.膀胱鏡で膀胱頸部4時に正常粘膜で覆われた有茎性腫瘍を認め, TUR-Btを施行した.病理所見では腫瘍表面を正常移行上皮が覆い, それに連続して索状, 網状に移行性上皮が内反性に増生しており, 細胞の異形成や悪性像は認めなかった.71歳男(症例3).頻尿, 尿勢低下, 尿線の途絶が出現し, 超音波で膀胱頸部近くに13×13mmの有茎性腫瘤を認めた.TUR-Btを施行し, 病理所見で腫瘍表面を正常移行上皮が覆い, 索状かつ乳頭状の内向性発育を示す異型性に乏しい移行性上皮の増殖を認めた

We report three cases of inverted papilloma of the urinary bladder. Case 1. A 19-year-old male complained of pollakisuria, gross hematuria and micturition pain. Cystoscopy revealed a smooth-surfaced tumor on a stalk at the bladder neck. The tumor was removed transurethrally. Histological diagnosis was inverted papilloma. As a safe guard, intravesical chemotherapy (Adriamycin) was performed, since pathological findings revealed a small region with mild atypical cells in the removed tumor. The patients has been subsequently followed up for ten years without any evidence of recurrence. Case 2. A 63-year-old male was admitted to our hospital because of a bladder tumor incidentally found by abdominal ultrasonography. The tumor was removed transurethrally. Histological diagnosis was inverted papilloma. The patient has been subsequently followed up for one year without any evidence of recurrence. Case 3. A 71-year-old male complained of pollakisuria, loss of urinary force and interruption of the urinary stream. A smooth-surfaced tumor found at the bladder neck was removed transurethrally. Histological diagnosis was inverted papilloma. Three months later, cystoscopy revealed two sessile papillary tumors on the left lateral wall of the urinary bladder. Pathological diagnosis was transitional cell carcinoma (G2, pTa). Although the inverted papilloma is a benign tumor, there is a possibility of recurrence or development of transitional cell carcinoma. Therefore, we advocate periodical follow-up examinations.