嚢胞状病変を伴った前立腺癌の1例

Abstract

排尿困難, 腹部膨満を主訴とした60歳男で, 直腸内指診で鵞卵大の前立腺を触れ, 表面は平滑で, 弾性軟であった.血清前立腺特異的抗原濃度は78ng/mlに上昇していた.骨盤CT及びMRIで大きい前立腺, 直径9cmの嚢胞状腫瘤, 及び内腸骨リンパ節腫脹を認めた.前立腺及び嚢胞の針生検で低分化腺癌を認め, 嚢胞内溶液は血性で, 細胞診は陰性であった.T4N3M0の前立腺癌と診断された.内分泌療法を行った.初診後4年の現在, 排尿障害もなく経過良好である

A 60-year-old man was admitted to our hospital with the chief complaints of dysuria and sense of abdominal fullness. On digital rectal examination, an enlarged prostate with a smooth surface and elasticity was palpated. The concentration of prostate specific antigen (PSA) was elevated to 78 ng/ml. Pelvic computed tomographic (CT) scan and magnetic resonance imaging (MRI) revealed a large prostate, 8 cm in diameter, with a cystic mass, and extra-iliac lymph node swelling. On needle biopsy of the prostate and cyst, the histology was poorly differentiated adenocarcinoma, and the aspirate comprised bloody fluid with a negative test for cytology. He was diagnosed with prostatic cancer of T4N3M0. This is the 19th case of prostatic cancer with cystic formation reported in Japan.