臨床的に腫瘍の存在が認められない尿細胞診陽性例の臨床的検討

Abstract

尿細胞診陽性(class IV, class V)のうち, 膀胱鏡検査で腫瘤性病変や粘膜変化がなく, 画像診断においても腫瘤の存在を疑わせる所見のない7例について, 臨床的な問題点をretrospectiveに解析した。検証7症例中5例は尿路上皮癌の既往があり, 経尿道的膀胱粘膜生検(TU-biopsy)で膀胱癌を1例, 尿管鏡で尿管癌を疑う腫瘍を1例, 6～8ヵ月の内視鏡検査・画像検査, 腎尿管摘除により尿路上皮癌を3例に認めた。尿路上皮癌の既往がなかった2例は, 肉眼的血尿を主訴とし, 1例は生検により, もう1例は24ヵ月後のCTで尿管癌を発見した。尿細胞診陽性であっても腫瘤の存在を疑わせる所見のない症例に対し, TU-biopsy, 両側尿管鏡を用いた検査や慎重な経過観察は必要だと思われた。

We retrospectively analyzed the clinical courses of 7 patients with clinically unconfirmed positive urine cytology characterized by persistent positive urine cytology but without any evidence of tumor by endoscopy or image diagnosis during the time from January 1999 to June 2004. A past history of urothelial cancer was found in 5 patients. In 2 of these 5 patients, transurethral resection of the bladder mucosa and ureteroscopy done as the initial examination identified bladder cancer and ureteral cancer, respectively. Urothelial cancer was found in the remaining 3 patients by subsequent endoscopy, image diagnosis and surgical resection that were done in the follow-up period of 8 months. Two patients who did not have a history of urothelial cancer were diagnosed as having bladder cancer and ureteral cancer in the initial or subsequent examination. Patients with clinically unconfirmed positive urine cytology should be carefully followed up with endoscopy and image diagnosis since the subsequent examinations tend to identify urothelial cancer in the upper urinary tract or bladder.