膀胱Sarcomatoid carcinomaの1例

Abstract

77歳男。主訴は膀胱移行上皮癌術後の腫瘍の再発であった。MRIでは膀胱頸部から後壁にかけて広範囲に腫瘍を認め, 前立腺への浸潤も疑われ, 経尿道的膀胱腫瘍切除術を施行した。組織診断はsarcomatoid carcinomaで, 膀胱全摘除術および右尿管皮膚瘻造設術を施行した。病理組織学的に腫瘍は明らかな上皮性の像を示す部分と異型性の強い肉腫様成分で構成され, 免疫組織学的検査では肉腫様成分で, 同一細胞がサイトケラチンとビメンチンを発現していた。術翌月に肺転移が出現し急速に増悪して1ヵ月後に死亡した。病理解剖では肉腫様成分のみで占められる両側胸膜播種性多発性転移と, 上皮性成分と肉腫様成分が混在する骨盤内局所再発を認めた。

A 77-year-old man was admitted to our hospital for a scheduled examination after transurethral resection of transitional cell carcinoma of urinary bladder. Tumor reccurence was found in the bladder by cystoscopic examination. Total cystectomy and unilateral cutaneous ureterostomy were performed. Histologically the tumor was composed of epithelial and sarcomatous elements. Therefore, we diagnosed this tumor as sarcomatoid carcinoma. The patient died of lung metastasis three months after operation. Autopsy findings showed lung metastasis and local reccurence which were composed of carcinomatous and sarcomatous elements. About 64 cases of sarcomatoid carcinoma of the urinary bladder have been reported in the Japanese literature and are reviewed briefly here.