尿路全摘除術を要した泌尿器系三重複癌の1例

Abstract

74歳男性。患者は検診にて尿潜血を指摘され, 著者らの施設へ受診となった。膀胱鏡では5mm以下の乳頭状腫瘍が全周性に認められ, 同時に行われたTUR-biopsyおよび前立腺針生検より膀胱腫瘍, 前立腺癌と診断された。腹部CTでは右腎上極に腎静脈浸潤を伴う腫瘍, ならびに被膜外浸潤, 左腎盂の腫瘍を認めた。以上より, 全尿路全摘の適応と判断し, 経腹的右腎摘除術, 左腎尿管膀胱前立腺全摘除術, 残存右尿管摘出術が施行された。その結果, 病理組織学的に右腎細胞癌, 左腎盂・尿管・膀胱の尿路上皮癌, 前立腺癌の同時性三重複癌であり, 術翌日より血液透析導入となった。術後13ヵ月現在, 再発はみられていない。

A 74-year-old male was referred to our hospital due to microhematuria that was pointed out at his health check-up. Cystoscopy showed many papillary bladder tumors under 5 mm in size. Intravenous pyelography also showed deformity of the right kidney and shadow defects in the left renal pelvis. Abdominal computed tomography revealed an 8 cm tumor invading the renal vein in the right kidney, and a 3 cm tumor in the left renal pelvis. Prostate biopsy was performed with PSA 3.4 ng/ml, and he was also diagnosed with prostate carcinoma. First, he received right radical nephrectomy, and secondly left nephroureterectomy and cystectomy. Our case should be called triple cancer because bladder cancer was thought to be daughter tumor of renal pelvic tumor. This is, to our knowledge, the 11th case report that occurred in the urinary tact, and the first case that needed total resection of urinary tract.