頸部リンパ節転移をきたした巨大前立腺癌

Giant prostate cancer with metastasis to the cervical lymph nodes：A case report

　74歳，男性。主訴は血尿。両側水腎症，骨盤内腫瘤を指摘され，当科に紹介された。PSA高値，下腹部腫瘤を認め，前立腺生検と画像検査を施行，cT4N1 M1の巨大な腫瘤を呈した低分化型前立腺癌であった。ホルモン療法を開始後，PSAは低下したが，頸部リンパ節腫大が出現した。生検すると，前立腺癌の転移であった。その後PSAが上昇したため，EMPとETPの内服を開始した。投与後，著明な白血球減少をきたし，肺炎で死亡した。

　A 74-year-old man presented with the chief complaint of macrohematuria and was referred to our department due to a pelvic mass and bilateral hydronephrosis. Laboratory finding showed renal dysfunction and the right percutaneous nephrostomy was performed. His serum PSA was as high as 909ng/ml and a hard mass was palpated on digital rectal examination. Transrectal needle biopsy of the mass revealed poorly-differentiated adenocarcinoma of the prostate. Under the diagnosis of a giant prostate cancer,cT4N1 M1,he was given hormonal therapy and his serum PSA decreased markedly,however,swollen cervical lymph nodes appeared bilaterally. The biopsy specimen of the lymph nodes revealed metastatic adenocarcinoma of the prostate. On the 51st day from the start of hormonal therapy,serum PSA began to increase and bone scintigraphy demonstrated new lesions. We started a combination of oral estramustine phosphate and etoposide but sever leukopenia was resulted and he died of the infectious pneumonitis.