膀胱肉腫様癌の1例

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63歳男.下腹部違和感を主訴とし,顕微鏡的血尿を認め膀胱鏡が施行され,膀胱腫瘍の疑いで精査となった.膀胱鏡検査,静脈性腎盂造影検査,骨盤部CT,MRIの検査所見から,膀胱右側壁の腫瘤と壁外浸潤が疑われ,経尿道的膀胱腫瘍切除術を施行した.免疫組織化学的に肉腫様増殖部分は非上皮性マーカーが陰性であったことから,膀胱肉腫様癌,G3,cT3以上と診断し,膀胱全摘除術,回腸導管造設術を施行した.化学療法,放射線治療などの追加治療は行わなかった.術後4ヵ月を経過しているが再発を認めていないA 63-year-old man was admitted to our hospital for a bladder tumor. Drip infusion pyelography, computerized tomography (CT) and magnetic resonance imaging suggested the presence of a large invasive tumor in the right wall of the bladder. Histopathological findings by transurethral resection of bladder tumor showed the presence of sarcomatous and carcinomatous elements. Immunohistochemical examination showed that the sarcomatous component did not stain for S-100 protein or for smooth muscle actin but it stained for epithelial markers. Under the diagnosis of sarcomatoid carcinoma, we performed a total cystectomy and ileal conduit without chemotherapy or radiation. A follow-up CT taken at four months postoperatively showed no evidence of recurrence.