膀胱Nephrogenic adenomaの2例

Abstract

症例1:52歳男.右腎コンゴ状結石, 膀胱瘻造設の既往があり, Friedreich病による四肢体幹麻痺と神経因性膀胱のため膀胱瘻にて尿路管理中に肉眼的血尿を呈した.経静脈的腎盂造影と膀胱鏡から膀胱結石と乳頭状腫瘍を認め, 経尿道的膀胱腫瘍切除(TUR-Bt)を行った.膀胱結石は膀胱瘻からアプローチし内視鏡的砕石術を行った.病理組織検査からnephrogenic adenomaと診断された.症例2:54歳男.1995年に表在性膀胱腫瘍の診断でTUR-Btを行い移行上皮癌であった.1996年に再発し塩酸ピラルビシン膀胱内注入療法を行い一部に上皮内癌を認めた.1998年の膀胱生検ではchronic cystitis, 1999年の再生検ではglandular cystitisの診断結果であった.今回, 肉眼的血尿を主訴とし, 膀胱鏡検査で膀胱壁全体に浮腫状の腫瘍を認め, 経尿道的膀胱生検を行い, 病理組織検査からnephrogenic adenomaと診断された.保存的治療に抵抗し膀胱全摘術を施行した

Case 1: A 52-year-old man receiving regular treatment for quadriplegia due to Friedreich disease visited our hospital with the chief complaint of macroscopic hematuria. He had undergone cystostomy 12 years ago due to neurogenic bladder. The computed tomography and cystoscopic examination revealed a bladder tumor with a few bladder stones. Transurethral resection of bladder tumor (TUR-Bt) was performed after bladder stone removal in May 2000. The pathological diagnosis showed nephrogenic adenoma. Case 2: A 54-year-old man had been treated with bladder tumor by TUR-Bt in Nov. 1995. The pathological diagnosis showed transitional cell carcinoma, G3, pT2 and intravesical instillation therapy using THP was performed. The bladder tumor had recurred twice and the instillation therapy had been exchanged to BCG since Nov. 1997. A small bladder tumor was observed in Jan. 2001, and from the biopsy specimen it was diagnosed as nephrogenic adenoma. Forty-six cases of urothelial nephrogenic adenoma including our cases have been reported in Japan. Chronic stimulation such as bladder stone and infection is thought to induce nephrogenic adenoma. BCG instillation therapy is believed to be an initiation factors for nephrogenic adenoma.