膀胱移行上皮癌経過観察中, 内反乳頭腫を認めた1例

Abstract

76歳女。患者は1993年, 膀胱鏡上, 右尿管口付近に非乳頭状, 広基性腫瘍を認めた。膀胱癌の診断で経尿道的膀胱腫瘍切除術(TURBT)が施行され, 病理学的に移行上皮癌(TCC)であった。追加治療後, 外来経過観察を行っていたが, 1995年に膀胱鏡上同部位に再発を認めた。だが放置し, 2000年に血尿が出現, 再診となり, 前回と同じ部位に同じ腫瘍を認め, TURBTが施行された。以後, 5年経過で右尿管口付近と後壁に同様の腫瘍を認め, TURBTを施行, 病理学的にinverted papilloma(IP)であった。更に翌年には, やはり前回と同じ部位に腫瘍が再発し, 4度目のTURBT目的で入院となった。この入院時, 患者は突然の頸部痛を訴え, 意識消失となり, 蘇生を試みたが死亡となった。尚, 病理解剖では直接死因は急性大動脈解離による心タンポナーデと診断され, 遠隔転移巣は認められなかったが, 右尿管口付近に腫瘍を認め, 再発腫瘍はTCC, pTa, G2であった。

A 76-year-old woman presented with gross hematuria. She had received transurethral resections (TURBT) twice for superficial bladder tumors near the right orifice. All pathologic findings demonstrated low grade superficial transitional cell carcinoma (TCC). Cystoscopy showed the tumor lesions during the follow-up. Bladder tumors were completely harvested and pathologic examination revealed inverted papilloma. However, recurrent tumors were detected at the same location after 4 months' follow up. Although she came to our hospital for the purpose of TURBT, she complained of severe neck pain and was suddenly dead. Autopsy findings showed that dissecting aortic aneurism was the cause of death and the bladder tumor was low grade superficial TCC. The case reported here had a very rare pathologic finding with a history of superficial tumors located in the same areas in the urinary bladder.