骨盤内臓器と肺の4重複癌

Quadruple cancer of the pelvic organs and lung：A case report

　患者は67歳，男性で，肉眼的血尿を認め，近医を受診した。PSA高値のため前立腺生検を施行し，前立腺癌と診断された。膀胱鏡で多発性乳頭状腫瘍を認めた。胸部CTにより，結節影を認め，左上葉部分切除術を施行した。病理診断は小細胞癌であった。大腸内視鏡検査を施行し，直腸に腫瘍を認めた。骨盤内臓全摘，回腸導管・人工肛門造設術を施行した。病理診断は，前立腺癌（中分化型腺癌），膀胱癌（非乳頭状移行上皮癌），直腸癌（高分化型腺癌）であった。改めて肺癌の病理組織を検討し，最終的に同時性4重複癌と診断された。

A 67-year-old man with gross hematuria visited a nearby clinic. He had increased serum PSA level,and biopsy of the prostate featured moderately differentiated adenocarcinoma. Cystoscopy showed multiple papillary bladder tumors. Computed tomography revealed a tumor mass in the left lung. The patient underwent a left upper partial lobectomy,and histopathological diagnosis was small cell carcinoma. Colon fiberscopy demonstrated rectal cancer in the preoperative examination. Then the patient underwent total pelvic exenteration with ileal conduit urinary diversion and colostomy. Histological diagnosis of each tumor was moderately differentiated adenocarcinoma of the prostate,non-papillary invasive transitional cell carcinoma,G3 of the urinary bladder and well differentiated adenocarcinoma of the colon. We finally diagnosed the patient as having synchronous quadruple cancer including lung cancer.