経時的尿路細胞診と尿路上皮腫瘍の管理

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1)経時的尿路細胞診が陰性の例では尿路腫瘍の再発は極めて稀である.しかし尿路外転移巣の出現に注意を払う必要はある.陽性と陰性を反復しながら内視鏡(レ線)的に腫瘍が確認されない症例では,一過性にまたは持続して潜伏性尿路上皮膚癌,または細胞診上それと鑑別の難しい異型性上皮が存在する可能性が大きい.大部分が陽性の症例は厳重に精査する必要がある.2) TUR-Btと術後膀注療法施行例では,術後2ヵ月目まで腫瘍細胞の残存が見られる場合が多いNinety-one patients with operation history for urotheliomas were followed-up by urinary cytology for 17.5 months on the average. Cytologically, fresh urine was examined every month and vesical irrigation fluid every three months. Cystoscopy was also performed every three months, IVP every six months, and biopsy was performed when carcinoma or dysplasia was suspected. As a result, cases were classified into four groups. Group 1: All cytological examination were negative. Group 2: Cytology was positive for two or three months after TUR-Bt during which period vesical instillation therapy of anti-cancer drugs was performed, but was negative after this period. Group 3: Positive and negative cytology were diagnosed irregularly. Group 4: All cytological examinations were positive. The numbers of cases classified into these groups were 27 (29.7%), 7 (7.7%), 43 (47.3%) and 14 (15.4%), respectively. Tumor recurrence was seen in 1/27 (3.7%), 0/7, 12/43 (27.9%) and 4/14 (28.6%) cases, respectively. Metastasis was seen in only five cases of the group 4. Tumor recurrence and positive urinary cytology at the same time were seen in nine cases (20.9%) of group 3, and eight cases (57.1%) of group 4. Thirty four cases (79.1%) with discrepancy of cytological and endoscopic findings in group 3, in which cases 20 cases had only positive irrigation cytology and 11 cases had positive fresh urine and irrigation specimens, were more suspicious of temporary existence of in situ carcinomas or dysplastic urothelium. Of six cases with the discrepancy in group 4, three cases were in situ carcinoma diagnosed by random biopsies, and four cases had positive cytologies after TUR-Bt continuously.(ABSTRACT TRUNCATED AT 250 WORDS)

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高橋茂喜
順天堂大

経時的尿路細胞診と尿路上皮腫瘍の管理

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