肺転移をきたした表在性膀胱癌の1例

Abstract

66歳女。膀胱鏡検査で頂部に最大径4.0cmの多発乳頭状広基性腫瘍を認め経尿道的膀胱腫瘍切除術(TURBT)を施行し, 病理組織診断はtransitional cell carcinoma(TCC), G1, pT1であった。その後, 再発を頻回くり返しTURBTを施行し, THP-ADM膀胱内注入療法を12回施行したが頂部に単発乳頭状腫瘍の再発を認めTURBTを施行した。この術前検査で右肺野単発結節状陰影を認め尿細胞診はclassII, 肺胞線状細胞診はclassVを認め, CTより右S3に約1cmの結節状陰影を認めたが遠隔転移巣は認めず胸腔鏡下右肺部分切除術を施行した。病理組織診断はTCC, G1で膀胱癌の肺転移と診断した。3ヵ月後に頂部に約5mmの乳頭状腫瘍を4ヶ所認め, BCG膀胱注入療法6回施行し, 同部位に残存を1ヶ所認めTHP-ADM膀胱内注入療法を6回施行したが, 腫瘍増大のためTURBTを施行した。病理診断はTCC, G1, pTaで術後BCG膀胱内注入療法を6回施行し, 現在に至るまで胸部も含め再発を認めていない。

A 66-year-old woman presented with a coin-size lesion in the right lung. Bronchoalveolar lavage cytology showed class V. Thoracoscopic partial pneumonectomy of right upper lobe was performed and pathologic finding was metastatic transitional cell carcinoma (TCC). She had a history of superficial bladder tumors which were treated with transurethral resection (TURBT). All pathologic findings demonstrated low grade superficial TCC. After the pneumonectomy, recurrent tumors were detected in the bladder after three months' follow up. Intravesical instillations and TURBT were performed and the pathologic finding showed superficial TCC. There have been no signs of recurrence during the six-year follow up. The case reported here is of superficial cancer with a metastatic lesion in the lung without local invasion in the urinary bladder.