播種性骨髄癌腫症を呈した前立腺癌の2例  [in Japanese] DISSEMINATED CARCINOMATOSIS OF THE BONE MARROW IN TWO PATIENTS WITH PROSTATE CANCER  [in Japanese]

Access this Article

Author(s)

Abstract

播種性骨髄癌腫症は固形癌のびまん性骨転移によって播種性血管内凝固症候群(disseminated intravascular coagulation;DIC),白赤芽球症(leukoerythroblastosis),最小血管障害性溶血性貧血(microangiopathic hemolytic anemia;MHA)を呈し,急激に予後不良な経過をたどる病態である.本症を併発した前立腺癌の2例を経験した.前立腺癌による播種性骨髄癌腫症の報告は稀であり,若干の文献的考察を加え報告する.症例1:61歳男性.PSA高値にて当科を紹介された.前立腺生検,画像検査にて前立腺癌(T3N1Mx)と診断された.MAB(maximum androgen blockade)療法がおこなわれたが,原因不明の消化管出血,治療抵抗性のDICを呈し,初診より2カ月後に癌悪液質にて死亡した.死亡後の骨髄生検にて骨髄への前立腺癌転移が確認された.症例2:68歳男性.血尿を主訴に当科を紹介された.膀胱鏡にて前立腺部尿道に非乳頭状腫瘍を認め,経尿道的生検を施行した.前立腺癌(T4N0M1)と診断され,MAB療法,ゾレドロン酸投与にて加療が開始された.治療開始8カ月後,倦怠感,貧血,血小板減少を認め,骨髄生検にて癌の骨髄転移と診断された.ホルモン交代療法,ドセタキセル療法が行われ,血球減少症は改善し,全身状態も回復した.<br>

Disseminated carcinomatosis of the bone marrow is caused by metastasis to the bone marrow and can cause disseminated intravascular coagulation (DIC), leucoerythroblastosis, and microangiopathic hemolytic anemia (MHA) . The prognosis of this syndrome is poor. We report herein two rare cases of disseminated carcinomatosis of the bone marrow in association with prostate cancer. Case 1 involved a 61-year-old man admitted to our department with elevated prostate-specific antigen (PSA) levels. Prostate biopsy revealed prostate cancer, and imaging studies were performed. Under a diagnosis of prostate cancer (T3N1Mx), the patient was treated using hormonotherapy, but died 2 months after admission due to gastrointestinal bleeding of unknown cause, refractory DIC, and cachexia. Bone marrow biopsy after his death revealed metastasis of the prostate cancer to the bone marrow. Case 2 involved a 68-year-old man admitted to our department with gross hematuria. Cystoscopy revealed non-papillary tumor in the prostatic urethra. Transurethral biopsy was performed and histology identified prostate cancer. Treatment was initiated with hormonotherapy and zoledronate. After 8 months, he complained of general fatigue and blood testing identified anemia and thrombocytopenia. Bone marrow biopsy revealed adenocarcinoma in the bone marrow. Alternative androgen therapy and chemotherapy with docetaxel was started, and the patient recovered from pancytopenia and general fatigue.<br>

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 102(1), 28-33, 2011-01-20

    The Japanese Urological Association

References:  9

Codes

  • NII Article ID (NAID)
    110008440745
  • NII NACSIS-CAT ID (NCID)
    AN00196577
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    00215287
  • NDL Article ID
    10943112
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-203
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
Page Top