膀胱における尿路上皮癌と悪性リンパ腫の衝突癌の1例

Abstract

70歳代男。患者は入院半年前から腰痛が出現, 腹部CTでも異常がみられた。更に精査を計画中に肉眼的血尿が始まり, 膀胱鏡では多数の凝血塊と左壁の乳頭状腫瘍を認めた。凝血塊の除去を行った後に, 即日入院となったが, 腹部CTでは肝臓のLDAと大動脈周囲のリンパ節腫脹を認め, 腹部MRIでは肝S5とS6に充実性腫瘤が認められた。また, 胃・膵頭部・腹腔動脈・SMA・傍大動脈周囲には多数のリンパ節腫脹が認められた。治療として脊椎麻酔下にTUR-Btを施行し, 肝のLDAに対しては超音波下肝生検が行われた。その結果, 膀胱は表在性尿路上皮癌と悪性リンパ腫の衝突癌, 悪性リンパ腫はNHL, B細胞型, stage IVと診断された。以後, 化学療法を1コース行い, 終了3週後からは肉眼的血尿は消失した。現在, 3年経過で体調は良好, 外来通院中である。

A man in his 70's visited the Department of Internal Medicine due to lumbago that had first appeared two months previously. Abdominal computed tomography showed a low-density area in the liver and swelling of lymph nodes surrounding the abdominal aorta. Four months later, he was hospitalized on an emergency basis in a urology ward in order to control bladder tamponade. Cystoscopy revealed massive blood clots and a papillary tumor at the left wall of the urinary bladder. He underwent transurethral resection of a bladder tumor, and the pathological diagnosis was a collision tumor between urothelial carcinoma (G2, pTa) and malignant lymphoma (B cell type). He underwent a liver biopsy soon thereafter, and the pathological diagnosis was malignant lymphoma (as for the one found in the urinary bladder). Bladder tamponade was repeated, which was relieved after one course of chemotherapy for malignant lymphoma. He underwent six courses of chemotherapy (THP-CO), and he was well without recurrence of either malignant lymphoma or urothelial carcinoma with 3 years' follow-up. To our knowledge, this is the 14th reported case of a collision tumor in the urinary tract.