異所性骨形成を伴った膀胱原発未分化癌の1例

Abstract

A 64-year-old man was admitted to our hospital with the chief complaint of macrohematuria in March, 1980. Cystoscopic examination revealed two vesical tumors on the right lateral wall and apex. TUR-Bt was performed and the histological diagnosis was grade 2 transitional cell carcinoma. Recurrence was discovered in September, 1980. TUR-Bt was performed again, and the diagnosis was, histologically, grade 3 transitional cell carcinoma. The 2nd recurrence was discovered in September, 1981. Preoperative examination with cystoscopy, CT scan, angiography, revealed an ulcerative, non-papillary, invasive tumor in the right part of the bladder. Telecobalt radiation and pepleomycin injection were given as preoperative therapy. Total cystectomy and urinary diversion with ureterocutaneostomy were done on October, 1981. At that time, it was found that the tumor had infiltrated through the bladder wall. Histological examination of the extirpated bladder showed massive infiltration of atypical and pleomorphic cells and giant cells in the entire bladder wall with heterotopic ossification, and osteoid metaplasia of connective tissue and transformation of fibroblasts to osteoblast-like cells, but no cartilage or bone marrow. Precise histological diagnosis was primary vesical undifferentiated carcinoma (UC, UIT, INFγ, pT3b, lyO, v(-)). Moderately differentiated adenocarcinoma of the prostate was also recognized. This case suggests that carcinoma cells can induce osteoid metaplasia of the connective tissue, and that carcinoma cells become osteogenetic.