膀胱癌肉腫の1例

Abstract

50歳男.無症候性肉眼的血尿を主訴とした.排泄性尿路造影にて右側壁に陰影欠損および右水腎症を認めた.骨盤MRI T2強調像にて膀胱内右尿管口部に一致して腫瘍があり, 筋層への浸潤が認められた.経尿道的膀胱生検術を施行したところ腫瘍の生検部位は壊死組織とのことであったが, 諸検査結果より浸潤性膀胱腫瘍と診断し, 膀胱全摘術および回腸利用新膀胱造設術を施行した.病理組織学的に上皮成分は移行上皮癌で, 非上皮成分は横紋筋肉腫であった.両者の間には光顕的にも免疫組織学的にも移行所見はなく, いわゆる癌肉腫と診断した.術後約10日目頃より尾骨部痛が出現, 白血球増加を認め, 術後約20日目頃からは下肢麻痺症状も出現した.術後20日目のCT像にて骨盤内に急激な腫瘤の増大を認め, 短期間の癌肉腫再発と診断した.その後状態は急激に悪化し, 術後36日目に死亡した

We report a case of carcinosarcoma of the urinary bladder. A 50-year-old man visited our hospital with asymptomatic macroscopic hematuria as a chief complaint. Excretory urography revealed a filling defect in the right wall of the bladder, and subsequent cystoscopy revealed a non-papillary tumor above the right orifice. The patient underwent total cystectomy and had a neobladder constructed with the ileum (Hautmann's method). Microscopic examination showed a tumor composed of a mixture of transitional cell carcinoma and rhabdomyosarcoma. Immunohistochemical examination showed that the area of epithelium component was positive for cytokeratin and the non-epithelium area was positive for vimentin, there being no relationship between the two. The patient began complaining of coccyalgia 10 days after the operation. He died about 1 month after the operation because of the recurrence in the pelvic cavities.