類似臨床を呈したBCG誘発肉芽腫性前立腺炎と膀胱上皮内癌前立腺浸潤

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類似臨床を呈したBCG誘発肉芽腫性前立腺炎と膀胱上皮内癌(CIS)前立腺浸潤の各1例を経験した.症例1は77歳男性.膀胱CISと再発CISにBCG膀胱内注入療法を2度施行したが,尿細胞診でclass 5を認め,3度目のBCG注入で強い頻尿と排尿時痛を認めて中断,直腸診で前立腺に硬結を触知し,TRUSで左葉にhypoechoic lesionを認めた.抗結核薬でも改善せず,TUR-Pを施行した.病理所見ではBCGによる肉芽腫性前立腺炎であった.症例2は71歳男性.膀胱CISにBCG膀胱内注入療法を開始し,4回注入後に膀胱刺激症状,排尿困難を認めたが,治療を継続して6回の注入を終了した.その後も尿細胞診でclass 3～5が継続し,排尿症状増悪で抗結核薬を使用したが改善せず,直腸診で前立腺に硬結を触れ,TRUSでhypoechoic lesionを認め,TRU-Pを施行した.病理所見では前立腺癌細胞は認めず,移行上皮癌であったIntravesical instillation of bacillus Calmette-Guerin (BCG) is the first-line therapeutic option for flat carcinoma in situ (CIS) of the bladder. Intravesical BCG instillation has been demonstrated to cause granulomatous prostatitis. Bladder CIS often also is known to show prostatic stromal invasion. We report a case of BCG-induced granulomatous prostatitis and a case of prostatic stromal invasion of bladder CIS accompanied by locally advanced prostate cancer, which showed similar clinical findings after the intravesical BCG therapy. In these 2 patients, urinary symptoms such as dysuria were prolonged regardless of anti-tuberculous medication, hard nodules were palpable at the prostate, and hypoechoic lesions were visualized by transrectal ultrasound. Both patients were treated by transurethral resection of the prostate, and the diagnoses were made by histopathological examination. Urinary symptoms were resolved in both patients after surgery, but the prostatic stromal tumor showed recurrence of growth. We report the usefulness of transurethral resection of the prostate for medication-resistant BCG-induced granulomatous prostatitis, and the importance of the correct diagnosis of prostatic stromal invasion of bladder CIS especially in the cases with concurrent prostate cancer.

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設楽敏也
渕野辺総合病院泌尿器科

類似臨床を呈したBCG誘発肉芽腫性前立腺炎と膀胱上皮内癌前立腺浸潤

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