長期間,頻回再発の膀胱癌の膀胱上皮に関する病理学的検討

Abstract

Two cases of bladder carcinoma treated by partial cystectomy, frequent transurethral resections and fulgurations for over 10 years, and final radical cystectomy are presented. Complete mapping of epithelium has been performed in the 2 bladders. Cross-sections of the entire bladders show widespread neoplastic process ranging from simple hyperplasia to non-invasive papillary carcinoma. These lesions had not been identified clinically or on gross examination of the bladders. Histological sections of the entire bladders also show extensive fibrosis in the submucosa and the muscularis. Multiple treatments by transurethral resection or fulguration seem to be responsible for these fibrotic changes. The clinical significance of diffuse abnormal urothelium that cannot be identified by cystoscopy is controversial. Yet the evidence to date implies that the chances of development of recurrent and infiltrating bladder cancer are much greater in patients with abnormal urothe1ium than in those patients in whom no abnormality of bladder epithelium is documented. Current approaches to the evaluation of patients with bladder carcinoma, considering only the grade and stage of the visible tumors, are inadequate. In order to improve long-term survival of the patients with bladder carcinoma, it seems important to consider aggressive treatments for patients with diffuse epithelial abnormalities.