集学的治療を施行した尿膜管癌の1例

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34歳女.肉眼的血尿を認めた.入院時,腫瘍マーカーはCA19-9,CEAがともに高値で,膀胱鏡検査にて膀胱頂部より突出する非乳頭状腫瘍を認め,生検で粘液産生性腺癌と認めた.骨盤部CTでは,腫瘍は膀胱頂部より連続し石灰化を伴っており,MRIのT2強調画像では,膀胱頂部から頭側に向けて高濃度を示す約6cmの腫瘤を認め,そのさらに頭側に遺残尿膜管を認めた.また,胸部CTにて左肺S3領域に石灰化を伴う約8mmの結節像を認めた.肺転移を伴う尿膜管癌と診断し,臍尿膜管摘出,膀胱子宮全摘,回腸新膀胱造設術を施行した.病理組織学的に,ムチン産生性の高分化型腺癌であった.その後,胸腔鏡下左S3部分切除術を施行し,病理組織学的に粘液産生性腺癌で,尿膜管癌肺転移と診断した.その後の経過観察中に,新たに尿膜管癌の肺再発を認め,Paclitaxel,Carboplatinを投与し,部分切除術を施行した.治療後14ヵ月現在,排尿状態は良好で,腫瘍マーカーは陰性化のまま,新たな転移を認めていないA 34-year-old married woman complaining of macrohematuria was admitted to our institute. Cystoscopy revealed a broad-stalk, nonpapillary tumor at the urinary bladder dome, and cold-punch biopsy proved it to be a mucus-producing adenocarcinoma. Abdominal managnetic resonance imaging demonstrated a tumor extending from the umbilicus to the bladder dome, and chest computed tomography (CT) demonstrated a small lung tumor with calcification. Examination of the upper gostroinstestinal tract, barium enema, and colon fiberscopy did not reveal abnormalities. We therefore diagnosed an urachal carcinoma with lung metastases. Total cystectomy, umbilical-urachal resection, hysterectomy, ileal neobladder, and partial resection of lung were performed, followed by partial resection of the left lung using thoracoscopy. About 6 months later, chest CT demonstrated multiple metastases in the right lung. After treatment with three courses of chemotherapy (paclitaxel and carboplatin), the right lung was partially resected. Serum CEA and CA19-9 levels were used to follow her disease, since both were elevated before the surgery and at the recurrence. Both indicators returned to their normal ranges after treatment. Such cases require careful observation using imaging modalities and tumor markers.
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集学的治療を施行した尿膜管癌の1例

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