Fluorescence in situ hybridization法癌細胞診断が補助診断として有用であった浸潤性腎盂癌の1例

Abstract

過去に2回膀胱癌に対して経尿道的切除が行われ, クラスV尿細胞診の為に入院した65歳男で, 腹部CTで左腎盂に増強されない直径1.5cmの低密度域が認められた.膀胱の無作為生検では悪性細胞は発見されなかった.逆行性腎盂造影で左腎盂や尿管に陰影欠損は認められなかった.右分腎尿の細胞診断はクラスIII, 左分腎尿のそれはクラスV, であった.蛍光in situハイブリダイゼーション法上, 右分腎尿から集めた細胞は正常の二染色体パターンを示したのに対し, 左分腎尿のそれは多染色体性随伴異数染色体パターンを示した.左全腎尿管摘除術を行った.病理組織学的に浸潤性腎盂癌と診断された

A 65-year-old man, on whom transurethral resection had been performed twice for bladder cancer in the past, was admitted to our hospital for further Class V urinary cytology examination. A low density area of 1.5 cm in diameter in the left renal pelvis without enhancement was the only abnormal sign on computed tomographic (CT) imaging. Malignant cells were not detected by random biopsy of the urinary bladder. The retrograde pyelogram showed no filling defect on the left renal pelvis or ureter. The cytological diagnosis of the right split renal urine was Class III, and that of the left split renal urine was Class V. Fluorescence in situ hybridization (FISH) analysis, using specific probes for chromosome 8q21.3 and the centromere chromosome 11, was performed on cells from the bilateral split renal urine. Cells collected from the right split renal urine showed a normal disomic pattern, while those from the left split renal urine included an aneusomic pattern with polysomy. Left total nephroureterectomy was carried out. Histopathology proved invasive renal pelvic cancer. Thus FISH analysis may be useful for the localization of renal pelvic or ureteral cancers, which are difficult to diagnose.