髄膜癌腫症をきたした筋層浸潤性膀胱癌

A patient with bladder cancer who responded to GC（gemcitabin, cisplatin）therapy, but died of meningeal carcinomatosis：a case report

79歳男性。両側腸骨領域，傍大動脈リンパ節転移を伴う浸潤性膀胱癌に対して術前GC（gemcitabine，cisplatin）療法を3コース施行後に，膀胱全摘除術，回腸導管造設術を施行した。病理学的所見はurotherial carcinoma，G3，pT2b，ly0，v0，リンパ節転移陽性であった。術後3か月のCTではリンパ節転移を認めなかった。術後6か月のCTで多発リンパ節転移を認めたため，GC療法を開始した。2コース終了後のCTでリンパ節転移の縮小を認めたものの，2コース目施行中に失見当識，下肢脱力を認め，頭部MRI，髄液検査で髄膜癌腫症の診断となった。積極的治療は行わずに緩和医療となったが，髄膜癌腫症の診断からおよそ1か月後に死亡した。

A 79-year-old man with invasive bladder cancer and metastases to the iliac and para-aortic lymph nodes underwent three courses of preoperative GC（gemcitabin, cisplatin）therapy, followed by total cystectomy and ileal conduit diversion. Histopathologic examination of the resected specimen revealed urothelial carcinoma, G3, pT2b, ly0, v0, with lymph node metastasis. CT performed three months later revealed no lymph node metastasis. However, CT conducted six months postoperatively showed multiple lymph node metastases, and GC therapy was resumed. Although a repeat CT after completion of two courses of GC therapy revealed shrinkage of the lymph node metastases, the patient began to show disorientation and lower-extremity weakness during the second course of GC therapy and head MRI and cerebrospinal fluid examination revealed the diagnosis of meningeal carcinomatosis. The patient was then administered palliative care instead of aggressive treatment, but died approximately one month after the diagnosis of meningeal carcinomatosis.