前立腺原発移行上皮癌の1例

Abstract

77歳男性.主訴は排尿困難, 右坐骨部痛であった.入院時の骨盤部CTでは前立腺は腫大しており, また, 右坐骨に一致して溶骨性の腫瘍を認めた.腹部MRI, 胸部MRIでは大動静脈間リンパ節, 縦隔リンパ節の腫大を認めた.前立腺針生検では多層化した腫瘍細胞の増殖を認め, 病理診断は移行上皮癌であった.また, 再検した以前の頸部リンパ節組織の病理組織像は中分化型前立腺癌であった.以上より, 腺癌成分を含む前立腺原発移行上皮癌と診断し, MEC療法と内分泌療法を開始し, 同時に坐骨転移巣に対し放射線療法を併施した.2ヵ月目の評価ではPSA値は正常化し, 前立腺やリンパ節は縮小した.右坐骨転移巣は再石灰化し, 骨痛も消失したが, 徐々に状態が悪化し, 入院13ヵ月後に癌死した

A 77-year-old man was referred to our hospital with a complaint of dysuria and right ischiodynia. He had had a hemi-thyroidectomy for thyroid cancer and right cervical lymphadenectomy three years and one year, respectively, before this visit. Prostate cancer was strongly suspected by transrectal examination with prostate specific antigen (PSA) elevated to 77.8 ng/ml. Pathological diagnosis of prostate biopsy specimen was transitional cell carcinoma with grade 3 malignancy and negative staining for PSA. Endoscopic examination showed a normal appearance of bladder and prostatic urethral epithelium. Urine cytology showed no malignant cells. However, immunostaining for PSA revealed that the cervical lymph node specimen resected before was moderately differentiated adenocarcinoma of prostate. He had multiple metastases to mediastinal and retroperitoneal lymph nodes and right ischium. Endocrine therapy (goserelin acetate depot, bicalutamide) and systemic chemotherapy (methotrexate, epirubicin, cisplatin) were performed combined with irradiation to right ischium metastasis. Two months later, he showed a complete response in PSA and partial response in lymph node metastases, but died of cancer 13 months later.