術前放射線化学療法が有効であった膀胱後部平滑筋肉腫の1例

Abstract

69歳男.排尿困難を主訴として入院.下腹部に小児頭大の腫瘤を触知, MRIで膀胱の背側に11.5×8.0×8.0cmの腫瘤を認め, 膀胱は著しく前方へ圧排され, 腎盂鏡を経尿道的に挿入, 針生検を行い平滑筋肉腫と診断した.術前に動注化学療法と放射線の骨盤内照射を行い4ヵ月後に腫瘍は35%の縮小が得られ, 膀胱後部腫瘍摘除術を行った.腫瘍のみを根治的に摘除でき, 大部分が壊死に陥っていたが, 一部vialbleな組織を認め, 組織像は生検とほぼ一致していた.偶然左腎腫瘍を発見, 左腎部分切除を行い, renal cell carcinomaであった

A 70-year-old man with dysuria was referred to our hospital. Computed tomography scan and magnetic resonance imaging demonstrated a large solid tumor in the retrovesical space. Transurethral needle biopsy revealed leiomyosarcoma. Since the size of the tumor decreased markedly by intraarterial chemotherapy with cisplatin, methotrexate and pirarubicin, in combination with radiotherapy (40 Gy), surgical extirpation of the tumor was performed. Neither infiltration to the adjacent organs or lymph node metastasis was recognized. The patient had been free of recurrence for 12 months after operation.