内視鏡上膀胱癌と慢性膀胱炎との鑑別不能例における組織学的検討

Abstract

内視鏡では膀胱癌が慢性膀胱炎か診断不能な27症例を膀胱腫瘍の既往のある群と既往のない群の2群にわけ, 病理組織学的検討をおこなった.1)それぞれの病理組織学的病変特有の内視鏡像は得られなかった.2)化生や増殖性膀胱炎は膀胱腫瘍の既往がない群にみられ, 慢性炎症に対し反応性に生じたものと思われた.3)上皮過形成は膀胱腫瘍の既往のある群に高率にみられることから, なんらかの腫瘍性機転を有しており乳頭状腫瘍の前駆状態である可能性が示唆された.4)尿細胞診は移行上皮癌3例中2例に陽性で, これらに対して有用であった.慢性膀胱炎が根底にあると, 細胞診はsuspiciousやpseudopositiveと判定されやすいため, 炎症の原因を取り除くとともに繰り返し施行することが大切である

Twenty-seven cases in which cancer could not be distinguished from chronic cystitis were reviewed. These cases were divided into those with and those without a past history of bladder tumor. The high frequency of hyperplasia in the group with a history of bladder tumor suggested that hyperplasia may be a precursor of papillary tumor. On the other hand, proliferative lesions such as cystitis cystica and metaplasia were encountered in the group with no history of bladder tumor and 50 percent had symptoms of chronic cystitis. These findings suggested that proliferative lesions in the bladder developed by inflammatory irritation. Urinary cytology was done in 18 cases. Cytology was positive in 2 of the 3 cases of transitional cell carcinoma. Therefore, urinary cytology was useful, but it did not provide distinction in two cases of follicular cystitis and a case of squamous metaplasia was false positive.