皮膚転移をきたした膀胱癌の1例

Abstract

68歳男。無症候性肉眼的血尿が出現し膀胱癌と診断され、以後13年間に再発・転移を繰り返し、経尿道的切除術、抗癌剤の膀胱腔内注入療法、放射線療法、膀胱全摘除術が行われていた。膀胱全摘から約2年後に前頭部、前胸部、背部、右腋窩、右上唇部に発赤を伴う隆起性病変が出現し、楔状切除を行い、病理組織学的所見より膀胱癌の皮膚転移と診断された。また、呼吸器内科での気管支鏡検査で左上葉気管支入口部に転移巣を認めた。胸部X-Pでは左無気肺を呈しており、造影CTでは右肺上葉に結節陰影、左肺門部リンパ節腫大を認めた。左肺門部腫瘤に対し放射線照射を行い、左無気肺は改善したが、全身倦怠感が出現し、腹部CTで肝・骨・左副腎・膵に転移巣が判明し、悪液質の進行にて死亡した。

Bladder carcinoma with skin metastasis is extremely rare. We herein report a case of a bladder tumor with skin metastasis. A 68-year-old man was referred to our hospital with macroscopic hematuria. Cystoscopy revealed a trigone papillary tumor. Transurethral resection of bladder tumor (TURBT) was performed and the pathological diagnosis was transitional cell carcinoma (TCC), pT1, G3. Thereafter, he received several courses of TURBT, intravesical chemotherapy (pirarubicin, bacillus Calmette-Guerin and mitomycin C) and intra-arterial chemotherapy because of recurrence. Thirteen years later, he underwent total cystoprostatectomy with neobladder formation. Histological examination revealed muscle-invasive bladder cancer with a staging of T3bNOM0. Two years and three months later, multiple firm nodules with eruptions appeared on the skin in several regions; they were resected and the histological findings revealed TCC. This indicated metastatic spread from the primary bladder TCC. He received only supportive treatment during this period due to renal dysfunction. He died four months after the manifestation of the skin metastasis due to multiple metastases.