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Abstract
症例は49歳女性.主訴は肉眼的血尿と排尿痛.凝血塊による膀胱タンポナーデをきたしたため入院した.膀胱鏡検査で膀胱頂部から前壁にかけて直径5cm大の広基性腫瘍を認めた.生検標本の免疫組織化学的検討により膀胱肉腫様癌の診断を得た.術前の画像検査では遠隔転移,所属リンパ節への転移を認めなかった.膀胱全摘術,回腸導管造設術を行った.病理所見では尿路上皮癌(grade 2)を伴う膀胱肉腫様癌pT3aN0M0であった.治癒切除し得たと判断し,術後補助療法は行っていない.術後14ヵ月を経た現在,再発を認めていない.膀胱肉腫様癌は極めて稀で,有効な化学療法や放射線療法が確立されていない予後不良な癌である.TUR-Bt後に急速に増大した報告もあり,組織学的診断の後には速やかに膀胱全摘術を行う必要があると考えられた.
A 49-year-old female visited to our department with complaints of gross hematuria and micturition pain. Cystoscopic examination revealed a 5-cm diameter solid broad-based tumor located at the front wall of the bladder. Histologically, the tumor was composed of grade 2 urothelial carcinoma (UC) element and sarcomatous spindle cell element. Immunohistochemical examination demonstrated that both UC and spindle cells were positive for cytokeratin. In addition, spindle cells did not stain for S-100 protein or smooth muscle actin. We diagnosed the tumor as sarcomatoid carcinoma and performed total cystectomy and ileal conduit without chemotherapy and radiation. The patient has remained without any evidence of recurrence for 14 months after operation. Sarcomatoid carcinoma of the bladder has aggressive malignant potential and poor prognosis. An appropriate adjuvant therapy for sarcomatoid carcinoma with metastasis has not been established. Total cystectomy is recommended as soon as possible after pathological diagnosis in the same manner as conventional high grade UC.
Journal
- The Japanese Journal of Urology [List of Volumes]
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The Japanese Journal of Urology 98(3), 576-579, 2007-03-20 [Table of Contents]
The Japanese Urological Association
