急速に進展した微小乳頭状膀胱癌

A case of rapidly progressive micropapillary bladder carcinoma

　患者は64歳，女性。主訴は無症候性肉眼的血尿。多発性，有茎性の乳頭状腫瘍を認め，経尿道的膀胱腫瘍切除術（TUR-Bt）を施行。3か月後再発し，TUR-Bt，BCG注入療法を行うも，4か月後に再発。MRI上筋層浸潤を認め，膀胱全摘除術を施行（尿路上皮癌G3＞G2および微小乳頭状膀胱癌，pT3a，pN＋）。術後，MEC療法を施行し，10か月後の現在，再発を認めていない。本組織型の膀胱癌の報告は，本邦8例目であった。

　A 64-year-old woman presented with gross hematuria. Cystoscopy demonstrated multiple papillary bladder tumors. TUR-Bt was performed but the bladder tumor recurred after 3 months. TUR-Bt and BCG therapy were performed. However,the bladder tumor recurred again after 4months and the recurrent tumor was invasive to the bladder muscle. Therefore,we performed total cystectomy. Pathological examination demonstrated urothelial carcinoma grade 3＞2 and micropapillary carcinoma. Due to right obturator lymph node metastasis,systemic chemotherapy was administered as a form of adjuvant therapy. Follow-up CT scan taken 10 months postoperatively did not show any evidence of recurrence.