腎, 膀胱, 前立腺の同時性三重複癌の1例

Abstract

82歳男.2ヵ月前より続く肉眼的血尿を主訴とし, 膀胱腫瘍が疑われた.膀胱鏡上に径4cmの結節性非乳頭状腫瘍と周囲に多発する乳頭状腫瘍を認め, CTスキャンで膀胱右側壁に径35mmの腫瘍, 左腎下極腹側に径6cmの腫瘍が確認された.膀胱癌の転移か原発性腎癌の鑑別のため血管造影を施行したところ, 腫瘍は血管に富んだ腎細胞癌の診断であった.また, CTスキャン上前立腺肥大を認め, PASの測定から前立腺癌が疑われた.膀胱腫瘍にTUR-BTを施行し, 病理学的には移行上皮癌であった.MRI上も膀胱腫瘍は筋層浸潤が明らかであったため, 根治的左腎全摘除術, 根治的膀胱前立腺全摘除術, 回腸導管造設術を施行した.組織学的診断は腎細胞癌, 膀胱移行上皮癌, 前立腺癌で, 腫瘍に連続性はなく同時性三重複癌であった.p53に対する免疫化学染色を行なった結果, 膀胱癌のみ陽性で他は陰性であり, 三重癌の発生にp53遺伝子の変異は関与しなかったと考えられた.術後経過良好で, 術後8ヵ月で再発は認めていない

A case of synchronous triple carcinomas arising in the kidney, bladder and prostate is reported. An 82-year-old man had gross hematuria. Urine cytology was positive and intravenous pyelography showed right hydronephrosis with a filling defect in the bladder. Computed tomography revealed a 4 cm mass in the bladder, enlarged prostate and 6 cm renal mass at the left kidney. Cystoscopy demonstrated a papillary broadbased tumor with some small satellite tumors in the bladder, and magnetic resonance imaging revealed muscle invasion of the bladder tumor. This patient underwent left radical nephrectomy and total cystoprostatectomy with ileal conduit urinary diversion as radical treatment. Histological diagnosis was renal cell carcinoma, transitional cell carcinoma of the bladder. Furthermore, well-differentiated adenocarcinoma was found incidentally in the prostate. Immunohistochemical staining with anti-p53 antibody for the three tumors showed positive staining only for the bladder cancer.