原発性尿管扁平上皮癌の1例 : CDDP/5-FU療法の使用経験

Abstract

肉眼的血尿, 左下肢しびれ感を主訴とした62歳男で, 画像診断は左水腎症, 骨盤骨に浸潤している左尿管下端の大きい腫瘤, 及び左閉鎖リンパ節転移を示し, 生検では未分化SCC(扁平上皮癌)であった.経皮的左腎瘻を造設した.CDDP/5FU療法により, 画像上38%縮小, 血中SCG抗原の64%減少をきたした為, 照射を追加し, 膀胱左壁部分切除を含め可及的腫瘍切除を行った.腫瘍切除後4ヵ月に肝転移が出現した.初診から14ヵ月後に死亡した

A case of primary squamous cell carcinoma of the ureter is reported. A 62-year-old male presented with gross hematuria and paralysis of the left leg. Abdominal computed tomographic (CT) scan and ultrasonography revealed left hydronephrosis, a massive tumor (8 x 7 cm) in the left distal ureter which invaded the pelvic bone (T4), and left obturator lymph node metastasis (N2). Pathologic examination of the biopsy specimen revealed poorly differentiated squamous cell carcinoma. Cisplatin (100 mg/m2, day 1) and 5-fluorouracil (960 mg/m2/day, days 2-6) were administered systemically in accordance with biochemical modulation regimen for head and neck squamous cell carcinoma, and a minor response was obtained (tumor regression rate 38%, serum SCC antigen regression rate 64%). Thereafter, resection of residual tumor was performed, resulting in noncurative operation because of direct invasion to the pelvic bone. Four months after tumorectomy, liver metastasis appeared, and the patient died of disease 14 months after the initial visit. Combination therapy with cisplatin and 5-fluorouracil is widely used for head and neck squamous cell carcinoma, and the response rate has been reported to be 46-94%. This regimen may also be effective against urological squamous cell carcinoma.