女性尿道原発悪性黒色腫の一例  [in Japanese] PRIMARY MALIGNANT MELANOMA OF THE FEMALE URETHRA: A CASE REPORT  [in Japanese]

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Author(s)

    • 鈴木 宏明 Suzuki Hiroaki
    • がん・感染症センター都立駒込病院腎泌尿器外科 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • 中西 泰一 Nakanishi Yasukazu
    • がん・感染症センター都立駒込病院腎泌尿器外科 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • 吉野 公二 Yoshino Koji
    • がん・感染症センター都立駒込病院皮膚腫瘍科 Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • 片岡 円 Kataoka Madoka
    • がん・感染症センター都立駒込病院腎泌尿器外科 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • 福島 啓司 Fukushima Hiroshi
    • がん・感染症センター都立駒込病院腎泌尿器外科 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • 鳶巣 賢一 Tobisu Kenichi
    • がん・感染症センター都立駒込病院腎泌尿器外科 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • 古賀 文隆 Koga Fumitaka
    • がん・感染症センター都立駒込病院腎泌尿器外科 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital

Abstract

<p>症例は60歳女性.外尿道口部出血を自覚し前医を受診した.MRIで外尿道口に20mmの腫瘤を認めた.経尿道的尿道腫瘍切除を施行し,病理組織学的に間質浸潤を示す尿道悪性黒色腫(MM)の診断であった.当院紹介となり尿道MMの診断の下,ミニマム創内視鏡下拡大尿道全摘除+膀胱瘻造設+センチネルリンパ節生検を施行した.病理組織所見は尿道MM,pN0(0/2),切除断端陰性であった.術後補助療法としてインターフェロン<i>β</i>投与を行ったが,術後1年のCTで両側副腎,左肺門リンパ節に転移を認めnivolumab開始となった.nivolumab 4コース施行後,CTで転移巣の増大の他,間質性肺炎が出現した.ステロイド投与行い間質性肺炎は改善傾向を示した.その後も積極的治療を希望され,ipilimumabの投与を開始したが,間質性肺炎の増悪のため治療継続不可能となった.治療開始から19カ月目に原疾患により永眠された.</p>

<p>We report a case of primary malignant melanoma (MM) of the female urethra. A 60-year-old female complained bleeding from the urethral meatus. MRI revealed a mass of 20 mm at the external urethral meatus. Pathological examination of transurethrally resected specimens revealed MM with stromal invasion. She underwent total urethrectomy plus cystostomy and sentinel lymph node biopsy. The tumor was pathologically confined in the specimen and no lymph node metastasis was found. She received interferone β as adjuvant therapy. However, she developed bilateral adrenal and pulmonary hilar lymph node metastases 1 year after urethrectomy. Although she started to receive nivolumab as salvage therapy, the disease progressed as well as development of interstitial pneumonia (IP) after four cycles. Following improvement of IP with steroid therapy, she started to receive ipilimumab, which resulted in the development of intolerable IP of grade 3. The patient finally died of MM 19 months after the initiation of treatment.</p>

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 109(2), 111-115, 2018

    THE JAPANESE UROLOGICAL ASSOCIATION

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