Cyclophosphamide誘発性と考えられる膀胱癌の3例

Abstract

症例1(36歳女), 症例2(63歳男)はWegener肉芽腫症に対し, 11年間にそれぞれ計104g, 100gのシクロホスファミド(CPM)の投与を受けた.症例3(50歳女)は再発性乳癌に対し, 計57gのCPM投与を受けた.3例とも肉眼的血尿を主訴として受診し, 膀胱鏡で出血性膀胱炎を合併した膀胱腫瘍を認め, 経尿道的膀胱腫瘍切除術を施行した.病理組織学的に, 症例1及び2は移行上皮癌(TCC)グレード2, 症例3はTCCグレード3であった.3例ともマイトマイシンCの膀胱内注入を, 温熱療法の併用或いは併用なしに施行された.症例1, 3は治療中であるが, 症例2は原疾患の増悪に伴う呼吸不全で死亡した

Three cases of cyclophosphamide (CPM)-induced transitional cell carcinoma (TCC) of the bladder are reported. A 36-year-old female (case 1) and a 63-year-old male (case 2) received CPM at total doses of 104 g and 100 g, respectively, for the therapy of Wegener's granulomatosis. A 50-year-old female (case 3) received CPM at a dose of 57 g for the therapy of recurrent breast cancer. They visited our institute with the chief complaint of macrohematuria. In all cases, cystoscopy revealed bladder tumor with hemorrhagic cystitis. They underwent transurethral resection of bladder tumor. Histological examination revealed grade 2 TCC in cases 1 and 2 and grade 3 TCC in case 3. All patients underwent intravesical instillation of Mitomycin C with or without hyperthermia. Including our 3 cases, 17 cases of CPM-induced bladder tumor have been reported in the Japanese literature.