陰茎悪性黒色腫の1例

Abstract

78歳男.陰茎腫脹を主訴とし, 近医で陰茎悪性黒色腫疑いと診断され, 精査加療目的で入院した.包皮から亀頭と陰茎根部に黒色, 結節状, 悪臭のある腫瘤性病変を認め, 両側の鼠径リンパ節を数個触知した.膀胱鏡では尿道への浸潤, 陰茎部MRIでは海綿体, 尿道, 前立腺への浸潤, 腹部CTでは内腸骨リンパ節腫脹を認めた.血液検査では腫瘍マーカー5-S-システイニルドーパ(CD)の高値を認めた.陰茎原発悪性黒色腫と診断し, 膀胱全摘, 陰茎全摘, 両側睾丸摘出, 骨盤内・両側鼠径リンパ節郭清を施行した.病理診断は結節型悪性黒色腫であった.術直後はCDが正常範囲に低下した.その後, 化学療法と免疫療法の併用を行い, 一旦は退院したが, 脳への多発性転移を認め, 術後12ヵ月目には腹膜転移を生じ死亡した

A 79-year-old male presented in December. In January, 2001, with complaints of black nodules and bleeding from the glans of the penis to the foreskin. Inguinal lymph nodes were palpable bilaterally. Clinical diagnosis was penile malignant melanoma. Cystoscopy and urethrography revealed urethral invasion of malignant melanoma, and magnetic resonance imaging (MRI) of the penis revealed invasion to prostate, and pelvic lymph node metastases in abdominal compuled tomography (CT) but no organ metastases. Total cystectomy, total penectomy, bilateral inguinal and pelvic lymph node dissection and bilateral ureterocutaneostomy were performed in February, 2002. The pathological findings were nodular malignant melanoma, pT4bN2bM1a, and the surgical margin was positive. After these therapies, chemotherapy was performed. Five months later, CT revealed multiple lung and brain metastases, and radiation therapy and chemotherapy were performed. Twelve months after the operation, he died of cancer. Review of the literature revealed that our patient is the thirtieth reported case of penile malignant melanoma in Japan since 1924. In 30 cases, stage III, IV were 20 cases and 16 cases performed operation.