経尿道的に切除し得た直腸癌術後膀胱内再発

A case of locally advanced rectal cancer in which bladder recurrence was successfully managed by transurethral resection

　症例は73歳，男性。腹部膨満感と食欲不振の精査および加療を目的に当院内科へ入院した。大腸内視鏡では直腸に全周性狭窄を伴う腫瘍を認め，CTで膀胱への浸潤を疑う直腸腫瘍を認めた。直腸癌および直腸癌膀胱浸潤の診断で直腸切断術，膀胱部分切除術および人工肛門造設術を施行した。病理組織上，膀胱への直接浸潤を伴う直腸癌であった。術後6か月目のCTにて膀胱内に突出する腫瘤を認め経尿道的切除術を施行，病理検索で原発巣と類似した腺癌の所見を認め，膀胱局所再発と診断した。経尿道的手術後13か月，無再発生存中である。

　A case of 73-year-old man was admitted to our hospital with complaint of abdominal fullness and appetite loss. Fiber colonoscopy and CT revealed advanced rectal cancer with suspicious of bladder invasion. At operation,tumor apparently invaded directly to bladder and also outside of rectal serosa,so we performed Hartmann's operation,including partial resection of the bladder wall and construction of loop colostomy. He had consecutively received systemic chemotherapy（FOLFOX4）,but 6 months after the operation,following CT revealed a pedunculated bladder mass at the initially operated lesion. Transurethral resection was performed and the pathological finding was compatible with adenocarcinoma,so the local recurrence of rectal cancer was made. Thirteen months after the second operation,he was in good health and there is no sign of local recurrence and metastasis.