膀胱全摘後にIndiana pouch内の尿管結腸吻合部に再発したCEA, CA19-9産生移行上皮癌の1例

Abstract

平成4年4月に手術した73歳男で, 組織学的にグレード3のTCC(移行上皮癌)であった.5年2月に肉眼的血尿を訴え, 静脈性腎盂造影で無機能右腎及びインディアン・パウチ内陰影欠損を認め, 血清CEA(癌胎児性抗原)・CA19-9値上昇のため, パウチ内結腸癌を疑った.パウチ内腫瘤の内視鏡的生検によりグレード2TCCと判明した.5年7月に右腎, 尿管, 及びパウチを一塊として摘出した.右腎・尿管の癌はグレード2TCCと診断された.術後21日に血清CEA・CA19-9値は正常範囲に戻った.右腎・尿管癌は組織化学的染色でCEA・CA19-9陽性であった.膀胱腫瘍でもCEA・CA10-9陽性細胞を認めた

A 73-year-old female with transitional cell carcinoma (TCC) of the bladder underwent total cystectomy and Indiana pouch replacement in April, 1992. Histological examination revealed grade 3 TCC. In February 1995, she complained of gross hematuria. Intravenous pyelography (IVP) revealed a right non-functional kidney and filling defect in the Indiana pouch. We suspected colon cancer in the Indiana pouch because the levels of serum carcino-embryonic antigen (CEA) and CA19-9 were elevated. Endoscopic biopsy of intrapouch tumor was done. Pathological examination revealed grade 2 TCC. In July 1995, right nephroureterectomy with resection of Indiana pouch was performed and the surgical specimen revealed renal pelvic and ureteral cancer, grade 2 TCC. The levels of serum CEA and CA19-9 returned to the normal range 21 days after the operation. CEA and CA19-9 histochemical stain of renal pelvic and ureteral cancer were positive. Also CEA-, CA19-9-positive cells were detected in the specimens of the bladder tumor from the total cystectomy performed in 1992. This rare case is discussed and the literature is reviewed.