膀胱小細胞癌の1例及び本邦報告例の臨床検討

Abstract

3ヵ月前に無症候性肉眼的血尿に気づいた50歳男で, 膀胱左壁の非乳頭状広基性腫瘍を認め, 臨床病期はT3N0M0であった.生検材料の病理診断は小細胞癌であった.最初に行ったシスプラチン-アドリアマイシンの動注術前化学療法は無効であり, 根治的膀胱摘除を行った.腫瘍組織は明らかに均質で, 管状ないし索状に配列した小細胞より成り, pT3bR1L2V0N0であった.電子顕微鏡上, 神経分泌顆粒を持つ小細胞癌と確認された.術後, シスプラチン, エトポシド, 及びイホスファミドより成るアジュバント化学療法を4クール行った.術後26ヵ月に腫瘍再発の証拠なしに生存している

A 50-year-old man presented with asymptomatic gross hematuria which he had first noticed 3 months earlier. Clinical examinations revealed a non-papillary, broad-based tumor on the left lateral wall of the urinary bladder with a clinical stage of T3N0M0. The pathological diagnosis of a transurethral biopsy tissue specimen was small cell carcinoma. Neoadjuvant intraarterial infusion chemotherapy using cisplatin and adriamycin was initially administered but proved to be ineffective. Thus, we performed a radical cystectomy. The tumor tissue was apparently homogenous and composed of small cells arranged in sheets and solid patterns, and was staged to be pT3bR1L2V0N0. An electron microscopic study confirmed small cell carcinoma with neurosecretory granules. Postoperatively, 4 courses of adjuvant chemotherapy consisting of cisplatin, etoposide and ifosfamide were administered. The patient is alive without any evidence of tumor recurrence 26 months after the operation.