膀胱上皮内癌 : 慢性膀胱炎との鑑別が困難であった症例について

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Seven cases of carcinoma in situ of the urinary bladder and infiltrative bladder cancer which developed from carcinoma in situ were reported. Our experience and review of literature on this subject show that carcinoma in situ of the urinary bladder simulates chronic cystitis not only in symptoms and cystoscopic findings but also in histological findings of biopsy specimens. Probably due to decreased intercellular cohesiveness, in situ urothelial carcinoma cells exfoliate easily into urine and characteristic histological feature of denuding cystitis, namely denudation of urothelium and submucosal edema and teleangiectasia, is produced. Nontuberculous, abacterial stubborn cystitis with positive urinary cytology strongly suggests carcinoma in situ of the urinary bladder and should be treated as such until otherwise proved. Gastroduodenostomy was performed. Histologic examination of biopsy material revealed reticulum cell sarcoma. The patient received a total of 3,000 mg of cyclophosphamide over a period of 30 days, thereafter bladder symptoms were not seen. Since jaundice appeared on March 7, 1974, she was intravenously readministered cyclophosphamide together with infusion of 5% Pentose. The total dose was 3,000 mg in a period of 30 days. A beneficial response to symptomatic treatment for hepatitis ensued. However, 3 days after cessation of the drug therapy, frequency, dysuria and urgency developed. Urinalysis, including culture, revealed no evidence of infection. Thiophenicol and nalidixic acid were given, but the symptoms became extremely severe. Six days later, gross hematuria occurred unassociated with clinical or chenlical evience of a bleeding diathesis. On April 16, cystoscopy was performed by us. The entire mucosal aspect of the bladder was involved by a diffuse, intense, hemorrhagic process which obscured all normal landmarks except each ureteral orifice. High infusion was done and sulfamethylthiadiazole, phenazopyridine, and diphehydramine were administered as conserVative treatments. Symptoms decreased in severity, and even microhematuria disappeared at 26 days following the occurrence of the bladder symptoms. Evidence of contracted bladder was not seen. Cyclophosphamide is unique among chemotherapeutic agents which possesscs the ability to produce sterile hemorrhagic cystitis. The symptoms are often mild and usually terminate following discontinuation of the drug. However, there are exarirples ofsevere, prolonged, and profuse bleeding, occasionally resulting in a fatal outcome. We feel that cyclophosphamide hemorrhagic cystitis embodies points of clinical and pathologic interest. The pathogenesis of the gross hematuria following cyclophosphamide therapy, histologic findings and several modes of treatment were discussed by reviewing the literature together with our animal experiment.
社団法人日本泌尿器科学会の論文
1974-12-20

膀胱上皮内癌 : 慢性膀胱炎との鑑別が困難であった症例について

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