A case of transitional cell carcinoma of the urinary bladder with high serum level of CEA and CA19-9

85歳男.血清CEA, CA19-9が高値を示した浸潤性膀胱腫瘍(移行上皮癌)であった.いずれの腫瘍マーカーも組織内での発現が確認され, 治療に伴う腫瘍サイズの減少と共に血清値の低下を認めた.治療開始後CEA, CA19-9は両方ともに腫瘍縮小にしたがい減少したが, その後CA19-9のみ上昇を認めた.原因としては, 1)画像では指摘できないサイズの再発, 転移が生じた, 2)水腎症の増悪によるCA19-9の上昇を生じた, 3)膀胱癌以外の悪性腫瘍の発生, などが考えられる.CA19-9の腫瘍組織内発現が確認されていることより, 1が最も考えられたが, CT等の画像や尿細胞診では病変の存在は指摘できなかった.腫瘍マーカー産生移行上皮癌において, これらの腫瘍マーカーが治療効果判定に有用であることが示された
An 85-year-old male with asymptomatic gross hematuria was diagnosed with invasive bladder tumor, transitional cell carcinoma grade 3. Serum levels of CEA and CA19-9 were elevated and histological examination revealed expression of both markers in the cytoplasm of cancer cells. Out of therapeutic options, intra-arterial chemotherapy and radiotherapy were selected because of his age. During the treatment, serum levels of CEA and CA19-9 decreased along with reduction of tumor size. These serum markers have been reported to be elevated in 10 to 60% of patients with bladder tumor and are useful markers for evaluation of the treatment as suggested in the present case.