膀胱癌手術拒否症例の1剖検例

Abstract

A case of untreated bladder cancer with an unusual clinical course in a 48-year-old man is reported. The patient noted painless gross hematuria 10 months prior to the first visit to our department on May 16, 1980. Cystoscopy revealed nonpapillary tumors in the right lateral and posterior wall. The histopathological finding was transitional cell carcinoma, grade II on biopsy. No metastatic lesions were found on clinical evaluation. Therefore, radical cystectomy with ileal conduit was planned. However, the patient refused the operation because he could not tolerate having the stoma on the abdomen. Because the patient had no complaint except for the past gross hematuria, he refused any treatment. The patient revisited our department 6 months after the diagnosis because swelling of the right thigh caused gait disturbance. A chest X-ray revealed pleural effusion, and an excretory urogram disclosed a right non-visualizing kidney and a large filling defect in the bladder. Cervical lymph nodes were swollen and several small nodules under reddish skin on the chest and abdomen were found to be metastatic lesions. Chemotherapy with cis-diamminedichloroplatinum, doxorubicin and 5-fluorouracil was ineffective in regressing the primary tumor although cervical lymph nodes and skin lesions responded at the induction. The patient died 29 months after the initial onset of the gross hematuria and 19 months after the diagnosis. Autopsy findings revealed metastasis in skin, diaphragm, left adrenal gland, stomach, small intestine, pericardium, right epididymis and lymph nodes.