膀胱憩室内に発生した扁平上皮癌

A case of squamous cell carcinoma in the vesical diverticulum

症例は66歳，女性。主訴は無症候性肉眼的血尿。画像検査で膀胱頂部に壁外浸潤を伴う憩室腫瘍を認め，経尿道的生検で扁平上皮癌（SCC）と診断した。膀胱部分切除術を施行するも，術後8か月で傍大動脈リンパ節転移が出現し，血清SCC抗原も上昇した。M-VAC化学療法を2コース施行するも転移巣はPDで，cisplatin併用放射線療法60Gyで転移巣は縮小したが，後に新病巣が出現した。Gemcitabine，nedaplatin併用によるGN療法を3コース施行し，SCC抗原は低下するも効果が乏しくなり癌死した。

A 66-year-old woman was referred to our hospital because of a diverticulum at the dome of the urinary bladder packed with a solid tumor on cystoscopy. Transurethral biopsy showed well differentiated squamous cell carcinoma（SCC）,but malignancy was not detected in the rest of the vesical mucosa. Pathological diagnosis after partial cystectomy was SCC＞UC,G3＞G2,pT3a. Eight months after the operation,paraaortic lymphnodes metastasis was detected. Two cycles of M-VAC（methotrexate,vinblastine,epirubicin,cisplatin）chemotherapy,and fellowing 60 Gy external radiation combined with cisplatin were of no effect. Three cycles of systemic combination chemotherapy consisting of gemcitabine and nedaplatin were then performed. However,24 months after the operation,the patient died of recurrent disease.