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42歳男。患者は会陰部～陰嚢内にかけての腫瘤を主訴とした。骨盤部CT検査では会陰部膿瘍が疑われ, 腫瘤の穿刺ドレナージを施行したが, 内溶液は血性であった。その後, 穿刺部から200～300ml/日の出血が続き, 内陰部動脈末梢に血管の増生を認めたため, 腫瘤は腫瘍性病変の可能性が高いと判断し, 内陰部動脈塞栓術の後, 会陰部・陰嚢内腫瘍摘出術が施行された。病理組織学的所見で上皮型の悪性中皮腫と診断され, 術中所見では腫瘍は不完全切除の可能性が高いと思われたものの, 病理学的所見では切除断端陰性であり, 術後は補助療法なしで経過観察とした。しかし, 術後2ヵ月経過で局所再発を来し, 再発部位からは高度の出血がみられ, 頻回の輸血を必要とした。再手術を施行したが, その後も再発を繰返し, 初診から6ヵ月後に患者は死亡となった。尚, 本症例では腫瘍は会陰部・陰嚢内の正中に位置し, 両側の精巣, 精巣上体, 精索への明らかな浸潤は認めず, 従来の報告にある発生部位とは異なっていた。このような部位に発生した悪性中皮腫の我が国での報告は2例のみであった。, We report here a case of malignant mesothelioma presenting as a perineal and intrascrotal mass. A 42-year-old Japanese male presented with an enlarging mass in the perineum and intrascrotum. Although the initial clinical diagnosis was perineal abscess, angiography revealed a tumor in the perineum and intrascrotum. The tumor was resected, and the pathological examination revealed malignant mesothelioma. Two months after the operation, a hard irregular mass with severe hemorrhage was noticed in the perineum, and was resected. A few weeks after the second operation local recurrence and, inguinal and intrapelvic retroperitoneal lymphadenopathy were found. Radiotherapy to recurrent sites was not effective. The patient died six months after the initiation of therapy. To our knowledge, 24 cases of malignant mesothelioma in the perineum or intrascrotum were reported in Japan and this case was thought to be the 25th case in Japan.

49歳女性。患者は肉眼的血尿と排尿障害を主訴に精査加療目的に著者らの施設へ入院となった。所見では腫瘍マーカーは正常で, 尿道膀胱鏡検査では膀胱頸部から尿道にかけ乳頭状腫瘍が認められ, 骨盤部MRIとCTでは尿道憩室内の腫瘍陰影が確認された。経尿道的膀胱尿道腫瘍切除術を行なったところ, 病理組織学的には尿道憩室腺癌と診断され, 患者が機能温存を強く希望したため, 経腟的尿道憩室摘除術が選択された。しかし, 術後約半年の尿細胞診にてclass Vが出現し, 局所再発が強く疑われた。膀胱尿道全摘術+回腸導管造設術を施行した結果, 現在, 6ヵ月経過で再発はみられていない。尚, 女子尿道憩室癌は稀な疾患であり, 我が国での報告例は本症例を含め18例を認めるのみであった。, A 49-year-old woman presented with complaints of dysuria and gross hematuria. Vaginal examination revealed an elastic-soft mass beneath the anterior vaginal wall. Urine cytology was positive. Urethrocystoscopy, magnetic resonance imaging and computed tomographic scan revealed a localized urethral diverticular tumor. Transurethral resection of the tumor was performed and the histopathologic finding was adenocarcinoma. Transvaginal urethral diverticulectomy was performed. Histopathological examination showed that the tumor arose in the urethral diverticulum and the proximal margin was positive. She had local recurrence at six months after the operation, and cystourethrectomy was performed. Six months after the operation, she had no evidence of recurrence. We review 18 cases of urethral diverticular carcinoma in Japan.

A case of primary signet ring cell carcinoma of the urinary bladder is described. A 59-year-old man presented with microscopic hematuria, and cystoscopy revealed a white nonpapillary tumor. Histopathological examination of the resected tumor revealed signet ring cell carcinoma and transitional cell carcinoma. Histological depth of invasion was pT1. No adjuvant therapy was performed. Primary signet ring cell of the urinary bladder is a rare tumor with 37 cases reported to date in Japan. We investigated previously reported cases and discussed adjuvant therapies of superficial signet ring cell carcinoma of the urinary bladder.