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前立腺乳頭状腺癌の4例を経験した.症例1は47歳.米国在住中に前立腺癌で前立腺摘出術を受け, 乳頭状腺癌であった.帰国後受診し多発性骨転移, 肺転移を認め, ホスフェストロール投与で消失したが, 左精巣腫大を認め両側精巣摘除術を施行し, 前立腺癌の左精巣転移であった.症例2は72歳.肉眼的血尿で受診し, 尿道鏡で広基性乳頭状腫瘍を認め, TURを施行し乳頭状腺癌であった.本人希望で経過観察中に精丘付近の尿道に再発を認め, フルタミド内服, 酢酸ゴセレリン注射で症状は改善した.症例3は72歳.前立腺肥大症で内服治療中, 尿道鏡で前立腺部尿道に乳頭状隆起を認め, 前立腺全摘術を施行し, 中分化腺癌と乳頭状腺癌の混在であった.症例4は64歳.尿勢不良で受診し, 直腸診で前立腺左様に突出を認め, 針生検を行い高分化腺癌の診断で前立腺全摘術を施行し, 高分化腺癌と乳頭状腺癌の混在であった, Papillary adenocarcinoma of the prostate, previously referred to as endometrioid carcinoma, is a variant of prostatic adenocarcinoma. Clinical and pathological evidence of involvement of the periurethral prostatic duct or verumontanum is usually required for definitive diagnosis of papillary adenocarcinoma. However, significant histologic and clinical features of papillary adenocarcinoma overlap with typical acinar carcinoma. Four cases of papillary adenocarcinoma were studied for the clinical features, histologic characteristics and immunohistochemical nature of prostatic specific antigen. In two cases, there were papillary regions, near the verumontanum, but in the other two cases, there were no papillary regions in the urethra. In two cases, acinar adenocarcinoma coexisted with papillary adenocarcinoma. All cases displayed positive immunohistochemical staining for prostatic specific antigen. In accordance with the observations of others, we suggest that papillary adenocarcinoma is one aspect of growth pattern of acinar adenocarcinoma, not a concept of a unique clinical and pathological entity.

9年前に前立腺肥大症に対し経尿道的前立腺切除術を受けた84歳男.血尿を主訴に受診したが, 直腸診所見やPSA値は正常範囲であった.約3年後, PSA値の上昇と共に血尿が増強した為膀胱尿道鏡を施行したところ, 前立腺部尿道に乳頭状腫瘍の密生を認め, 前立腺左葉芽前立腺肥大様に突出していた.X線検査でも前立腺部尿道に辺縁不整な陰影欠損を認めた.以上より, 後部尿道腫瘍及び前立腺肥大症と考えられ経尿道的切除術を施行した.術後の骨盤CTで左精嚢浸潤を認めたがリンパ節腫大はなく, 骨シンチも正常な為, 前立腺乳頭状腺癌T3N0M0と診断した.放射線治療を行い, 血尿の消失とPSA値の低下を認めた.PSA値の推移によってはホルモン療法の導入も検討している, We report a case of papillary adenocarcinoma of the prostate found by urethroscopy. An 84-year-old male visited our hospital complaining of initial hematuria in July 1997. No abnormal findings were detected despite repeated urological examinations until endoscopic examination revealed fine papillary tumors in the prostatic urethra along with benign prostatic hyperplasia-like prominent left lobe of the prostate in June 2000. Serum prostate specific antigen (PSA) level was 4.1 ng/ml. He underwent transurethral resection of the urethral tumors and the prominent lobe, which was found to contain packed papillary tumors. Both of these tumors were well differentiated papillary adenocarcinoma most likely originating from the prostate because PSA immunostaining was positive. The prostate was irradiated postoperatively. Papillary adenocarcinoma localized in the prostate is difficult to diagnose preoperatively.

症例1:74歳男.顕微鏡的血尿を主訴とした.膀胱尿道鏡検査にて膀胱後三角部および前立腺部尿道にそれぞれ単発性の乳頭状有茎性腫瘍を認め, 多発性移行上皮癌の疑いでTUR-Btを施行した.病理組織学的に乳頭状腺癌と診断した.症例2:71歳男.肉眼的血尿を主訴とし, 尿道鏡検査にて前立腺部尿道精丘付近に乳頭状腫瘍を認めた.TUR-Pを施行し, 病理組織学的に乳頭状腺癌と診断した.症例3:68歳男.頻尿と排尿困難を主訴とし, 血清PSA高値と画像所見より前立腺部尿道周囲癌を疑い, TUR-Pを施行した.病理診断は乳頭状腺癌で, 前立腺全摘術と回腸導管造設術を施行した.全例再発を認めていない, We report here 3 cases of papillary adenocarcinoma of the prostate. In all 3 cases, the tumors were discernible on cystourethroscopy and transurethral biopsy established the diagnosis, whereas no significant finding was found on digital rectal examination. Although androgen deprivation therapy was administered in all cases, different surgical procedures were employed according to the stage in each case. In case 1, since the papillary tumor was confined within the prostatic urethra, complete resection was accomplished by transurethral resection (TUR). In case 2, since pelvic lymph nodes metastases were found, local radiation therapy was added. In case 3, since the patient had vesical invasion of tumor total cysto-prostatectomy was performed. Papillary adenocarcinoma of the prostate originates from the prostatic duct, resulting in existence at the "central portion" of the prostate gland. Cystourethroscopy and transurethral biopsy is helpful for diagnosis of this disease, whereas rectal digital examination is useless. As a surgical procedure for the primary site, TUR may be efficient for tumors confined within the prostatic urethra, although more extensive surgery may be necessary for those with a more invasive profile.

We report a case of renal cell carcinoma with polymyositis. A 62-year-old female with a diagnosis of polymyositis was referred to our department because of the right renal mass discovered by computed tomography. An ultrasonography and renal angiography showed a solid and hypovascular area at the middle pole of the right kidney. A fine needle aspiration biopsy of the mass was performed and the cytology showed a papillary adenocarcinoma. Therefore, the right radical nephrectomy was carried out and her myopathic symptoms were slightly improved postoperatively. The patient has remained well without recurrence or metastasis for two years.

A case of prostatic papillary adenocarcinoma is reported. A 70-year-old male was admitted with the complaint of urinary retention. Suprapubic prostatectomy was performed on July 17, 1984 under the diagnosis of benign prostatic hypertrophy. The bilobes of prostate were 4 X 3 X 3 cm in size and 60 gm in weight. They were very soft and yellow-red. The histopathological examination revealed papillary adenocarcinoma of prostate. Glands were lined by a single or two layers of cuboidal cells with dark cytoplasm and a clear nucleolus. It seemed to arise from the prostatic duct, since serum level of prostatic acid phosphatase was elevated. But it was thought that prostatic carcinoma of acini grew in the papillary pattern, too. Therefore, it was difficult to identify the origin. Only hormone therapy (Honvan) was performed as postoperative anticancer therapy. During the follow up at the clinic, there have been no abnormal findings.