Primary choriocarcinoma of the urinary bladder

Abstract

A 72-year-old woman with asymptomatic macrohematuria was referred to our hospital. Cystoscopy revealed a 7 cm sessile tumor on the left lateral wall of the bladder. Subsequently an intravenous pyelography revealed left hydronephrosis. We performed transurethral biopsy and resection of the bladder tumor under the diagnosis of ordinary malignant bladder tumor. Histopathologically, the lesion was shown to be an undiffentiated urothelial carcinoma, G3, > or = pT2, containing syncytiotrophoblastic giant cells. The level of serum human chorionic gonadotropin-beta (hCG-beta) level was slightly elevated (0.3 ng/ml; normal value: < 0.1). Because a further examination revealed an invasion into the surrounding fat tissue of the bladder and left ureter, a total cystohysterectomy with an ileal conduit were performed. The final histopathological classification was choriocarcinoma of the urinary bladder, pT3a, pN1, pMx. An adjuvant combination chemotherapy was carried out using methotrexate, vinblastine, adriamycin and cisplatin (MVAC). After two courses of chemotherapy, the serum hCG-beta levels returned to normal. Eleven months postoperatively, however, there was evidence of multiple lung metastases. The patient died 12 months after the surgery as a result of complications caused by widespread metastases.

症例は72歳の女性。肉眼的血尿のため受診。膀胱鏡では膀胱左側壁にinvasive type, 7cm大の腫瘍が認められた。経尿道的膀胱腫瘍切除術を行ったところ病理組織学的にはsyncytiotrophoblastic giant cellが混在した未分化な尿路上皮癌の形態を示しG3, ≧pT2の結果であった。また血清hCG-βは0.3ng/mlと上昇していた。MRIでは膀胱周囲脂肪織および左尿管下端への浸潤が確認された。このため膀胱子宮全摘, 回腸導管造設術を行った。最終的な病理診断は膀胱絨毛癌であった。術後MVAC療法を2クール実施し, hCG-βは基準値以下に低下したが11ヵ月目に多発性肺転移が出現し12ヵ月目に癌死した。(著者抄録)