早期に筋層浸潤へ進展した原発性膀胱上皮内癌

Early Progression to Muscle Invasion in a Case with Primary Carcinoma in situ of the Bladder

　血尿を主訴とした43歳，男性。膀胱鏡で腫瘍を認めず，尿細胞診はclassⅤ，膀胱生検では剥離性膀胱炎であった。尿細胞診陽性と膀胱刺激症状が続いたため，1年8か月後に再度生検を行い，5／8の標本で上皮内癌（CIS）を発見した。膀胱全摘の標本には浅部筋層浸潤を示す移行上皮癌を認めた。本症例では生検により複数箇所でCISを認め，かつ膀胱容量減少をみたので，早期に浸潤するCISと考え，膀胱内注入療法は行わず膀胱全摘を選択した。

A 43-year-old man visited our clinic with complaints of hematuria and dysuria. No overt tumor was detected on cystoscopic examination. Bladder washing urine cytology revealed class V. Biopsy of the bladder, however, gave the finding of denuding cystitis. Since bladder irritability increased as well as persistent positive cytology, systematic bladder biopsy was repeated 18 months after the initial visit. CIS was found in 5 out of the 8 preselected sites. Radical cystectomy was promptly performed and the surgi-cal specimen disclosed two foci of TCC, grade 3, showing invasion to the superficial muscle.