集学的治療を施行した原発性女子尿道腺癌の1例

Abstract

A 64-year old female presented with urinary retention. Physical examination revealed a firm mass on the anterior vaginal wall. Magnetic resonance imaging showed a tumor surrounding the urethra, which invaded to the vesical triangle and the anterior vaginal wall. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated, but squamous cell carcinoma antigen and prostate specific antigen were within normal limits. Pathological examinations of the transurethral and transvaginal needle biopsy specimen suggested mucinous adenocarcinoma. First, the patient received local chemoradiotherapy and systemic chemotherapy using a fluoropyrimidine drug TS-1 and cisplatin. The tumor markers declined to within normal limits after this preoperative therapy. Then she underwent total cysto-urethrectomy with anterior vaginal wall resection, pelvic lymphadenectomy, and urinary diversion with ureterocutaneous fistula. Histopathological examination of the surgical specimen showed mutinous adenocarcinoma invading to the vesical triangle and the anterior vaginal wall. No metastasis was found in the lymph nodes. The final diagnosis was urethral adenocarcinoma, pT4N0, Stage IV. Five months after surgery, local recurrence and distant metastases appeared, and she died 14 months after surgery.

64歳女。尿閉を主訴とした。尿道膀胱鏡で、尿道後壁から膀胱三角部にかけて正常粘膜に覆われた隆起性病変を認めた。経尿道的および経腟的に腫瘤生検を施行し、消化管内視鏡で悪性腫瘍を認めず、尿道原発の腺癌と考え、原発性粘液産生性尿道腺癌と診断した。術前にCDDP 併用放射線化学療法およびTS-1/CDDP全身化学療法を施行した。病理診断後は消化管の腺癌に準じたTS-1/CDDP全身化学療法を施行した。これにより腫瘍マーカーの正常化を認めたが、画像所見では明らかな腫瘤の縮小は認めなかった。術前補助療法開始から約3ヵ月後、子宮・両側附属器・腟前壁切除を伴う膀胱尿道全摘除術、骨盤内リンパ節郭清を施行した。術中、右側肛門拳筋筋膜に腫瘍の癒着を認め、合併切除した。術後経過は良好であったが、術後5ヵ月で局所および肺・鼠径リンパ節に再発を認めた。その後、腸閉塞の増悪と寛解を繰返しながら全身状態が悪化し、術後約15ヵ月に死亡した。