Squamous cell carcinoma of the urinary bladder after intravesical bacillus Calmette-Guerin therapy for carcinoma in situ : a case report

88歳女性.患者は肉眼的血尿で受診した.尿細胞診陽性(クラス V), 膀胱鏡で左側壁に1cmの隆起性病変を認め, 経尿道的膀胱腫瘍切除術を行い, 病理診断は移行上皮癌(TCC)であった.4ヵ月後尿細胞診が陰性化せず, 生検でTCCと診断された.膀胱内BCG注入療法を拒否され, 約1年後膀胱鏡で全面に発赤拡大を認め, イムノブラダー膀胱内注入療法を行ったが改善せず, 膀胱鏡・CTで腫瘤性病変はなく, 再度の注入療法で尿細胞診は一時クラス IIIとなったが, 患者は腰痛で来院がなく, 3ヵ月後に肉眼的血尿と膀胱タンポナーデで緊急入院した.CT・MRIで膀胱右側壁に4cmの腫瘤を認め, 浸潤性膀胱腫瘍の診断で膀胱全摘除術, 両側尿管皮膚瘻造設術を施行した.病理診断は扁平上皮癌で, 膀胱内にTCCを一部認めた
A 88-year-old woman presented with bladder tamponade caused by gross hematuria. She had received 2 courses of bacillus-Calmette-Guerin (BCG) intravesical instillation therapy 4 months previously because of the bladder tumor with carcinoma in situ (CIS). Imaging studies and cystoscopy showed a bladder tumor invading into perivesical fat. She underwent total cystectomy and bilateral ureterocutaneostomy on May 27, 2002. Histopathologically, the tumor consisted of squamous cell carcinoma and transitional cell carcinoma.