嚢胞形成を伴った前立腺癌の1例

Abstract

80歳男.排便困難を主訴に発見された嚢胞形成を伴った前立腺癌の症例を報告した.排便困難, 便柱狭小を主訴とし, CT検査にて前立腺に接した嚢胞性病変を認め入院となった.MRI検査にて直腸腹側に前立腺と連続する壁在結節を伴う嚢胞性構造を認めた.骨シンチにてEOD grade2の転移を認めた.臨床的病期T2b N0 M1b, stage IVの嚢胞形成を伴った前立腺癌と診断した.ホルモン治療にてPSAは低下し, 測定感度以下になった.CTにおいては前立腺, 嚢胞ともに縮小傾向を示し, 治療開始後12ヵ月経過時点でPSA測定感度以下を持続し, 明らかな局所再発, 病変は認めていない

We treated a case of prostate cancer with cyst formation in an 80-year-old Japanese man presenting with constipation. Fist-sized elastic soft mass was palpable by digital rectal examination. Computed tomography and magnetic resonance imaging demonstrated a retrovesical cystic mass arisen from the prostate. Serum prostate-specific antigen (PSA) was elevated to 15.7 ng/ml. Transrectal prostate needle biopsy revealed moderately differentiated adenocarcinoma and puncture of the cyst yielded aseptic bloody fluid. With a clinical diagnosis of prostate cancer (T2b N0 M1b) with cystic formation, hormonal therapy with a luteinizing hormone releasing hormone analogue and bicalutamide significantly lowered the serum PSA level. One year later, the cyst was reduced in volume and constipation had resolved. A total of 57 cases of prostate cancer with cyst formation are reviewed.