膀胱瘻部に発生した未分化癌

A case of undifferentiated bladder cancer in a patient with cystostomy

　症例は77歳，女性。HTLV-1関連脊髄症で約12年前に膀胱瘻造設。2007年3月，肉眼的血尿が出現した。膀胱鏡，CTで明らかな悪性所見はなく，尿細胞診は陰性であった。膀胱瘻挿入部の巨大な腫瘤からの出血と診断。腫瘤部の疼痛改善，再出血予防目的で膀胱瘻挿入部腫瘤切除術および膀胱瘻再造設術を施行した。膀胱未分化癌（cT4bN0M0）と診断。術後，残存腫瘍に外照射を行いPRの効果を得たが，診断後8か月で癌死した。

　A 77-year-old woman with HTLV-1 associated myelopathy had been managed by cystostomy for 12 years. Gross hematuria appeared in March 2007,but malignant findings were not seen in cystoscopy and computed tomography. Urine cytology was negative. Our initial diagnosis was bleedings from the large tumor around cystostomy site,but we performed tumor resection and construction of cystostomy to control tumor re-bleeding and pain around the cystostomy. Pathological findings showed that the tumor was undifferentiated carcinoma of the bladder. We diagnosed undifferentiated carcinoma,cT4bN0M0. After operation,partial response was achieved by extra beam radiotherapy but the patient died of bladder cancer 8 months after the diagnosis.