膀胱全摘除術および回腸導管造設術後11年目に上部尿路再発を経て導管内再発を認めた症例

A case of late recurrence of urothelial carcinoma in an ileal conduit after radical cystectomy and ileal conduit diversion for bladder cancer

　82歳男性。2000年7月に血尿，頻尿を主訴に精査し膀胱上皮内癌と診断。BCG療法抵抗性のため2001年根治的膀胱全摘除術回腸導管造設術を施行。2006年に右尿管再発を疑う腫瘍を認め右腎尿管摘除術を施行。尿管断端は陰性で病理結果は尿路上皮癌，pTis。2012年6月外来経過観察中に血尿が出現し内視鏡で導管内腫瘍を認め，回腸導管摘除術・左尿管皮膚瘻造設術を施行。右遺残尿管吻合部を中心に腫瘍を認め病理結果は尿路上皮癌であった。

A 70-year-old man presented complaining of hematuria, and was diagnosed as invasive bladder cancer. After intravesical BCG therapy, cystectomy and ileal conduit plasty were performed（Urothelial Carcinoma, pTisN0M0G3）. At 76 years of age, urothelial carcinoma recurred in the right renal pelvis. He underwent right radical nephroureterectomy（Urothelial Carcinoma, pTis G3）. At 82 years of age, hematuria appeared and histological examination revealed urothelial carcinoma in an ileal conduit. The patient had another episode of recurrence in the ileal conduit 11 years after the initial operation. Urothelial carcinoma occured in an ileal conduit after radical cystectomy for bladder cancer is infrequently reported. To our knowledge, only 14 cases, including ours, have been reported.