膀胱上皮内癌の経過観察中にみられた膀胱平滑筋肉腫

Leiomyosarcoma and Transitional Cell Carcinoma in the Same Urinary Bladder

　76歳，女性。尿細胞診異常を認め，膀胱ランダム生検を施行し膀胱上皮内癌と診断した。Bacillus Caimett-Guerin（BCG）療法を施行するも尿細胞診は陰性化しなかった。経過観察中，膀胱後三角部に大きさ約2cm，灰白色の隆起性病変を認めた。TUR-Btを施行したところ，病理組織は平滑筋肉腫であった。本人の同意が得られなかったために膀胱全摘除術を施行せず，10か月後に腫瘍死した。膀胱移行上皮癌と平滑筋肉腫の合併例は本邦3例目である。

The patient was a 76 year-old woman whose urine cytol-ogy showed class 5. She was diagnosed as transitional cell carcinoma in situ by random biopsy of bladder mucosa. Therefore an intravesical instillation of BCG was performed, but urine cytology remained positive. One year later, cystoscopy disclosed a solid mass of about 2cm in diameter, covered with gray and white mucosa, located at trigone. TUR-Bt was performed. Histopathological diagnosis was leiomyosarcoma. She did not accepted operation and died of leiomyosarcoma.