18F-FDG PET/CTが診断・治療に有用であった膀胱癌全摘後骨盤内再発の1例

Abstract

58歳女。患者は2004年5月に無症候性肉眼的血尿を認め, 更に膀胱鏡で左側壁に非乳頭状腫瘍が確認された。TUR-Btを施行したところ, 病理組織学的所見ではurothelial carcinoma, G3, pT1以上であった。治療として放射線化学療法後に, 鏡視下小切開膀胱全摘・骨盤リンパ節郭清・回腸導管造設術を施行したものの, 2005年9月に左大腿および下腿に重度の浮腫が出現した。そして2006年1月に骨盤内の再発を検索し, 本症例が膀胱癌左骨盤リンパ節再発であることが診断された。以後, 放射線化学療法を施行した結果, 治療開始約1ヵ月後に左下肢の浮腫は著明に改善し, 2ヵ月後にはほぼ消失, 10ヵ月が経過現在, 左下肢浮腫の再発はなく, 他部位への転移も認められていない。

A 58-year-old woman visited our hospital with complaints of serious edematous change in the left lower extremity, eleven months after she received total cystectomy and ileal conduit. Although enhanced pelvic computerized tomography (CT) and magnetic resonance imaging (MRI) were repeatedly performed, the pelvic recurrence was not detected. To investigate the presence or absence of pelvic recurrence further, we performed 18F-fluorodeoxyglucose positron emission/computerized tomography (18F-FDG-PET/CT). 18F-FDG-PET/CT clearly demonstrated high uptake by the pelvic lymph node recurrence. We selected radiochemotherapy using a limited irradiation field for the treatment of lymph node recurrence to cure the edema. One month after the treatment, the edema in the left lower extremity was greatly improved. Four months later, 18F-FDG-PET/CT was performed again to evaluate the efficacy of the treatment and reduced uptake of the irradiation field was observed.