いわゆる Silent Bladder Cancer について

抄録

Cystoscopy is the most important method in the diagnosis of bladder cancers. However, some cases can not be diagnosed by cystoscopy. We had six cases of the socalled silent bladder cancer, in which the surface of the bladder was nearly normal or with appearance of chronic inflammation, and the sign of tumours could not be detected by the cystoscopical examination. Therefore, we report our experience and give some considerations on the diagnosis and treatment of such cases.
Of all six cases, five cases had received the medical treatment in a certain hospital from 3 months to 3 years under diagnosis of chronic cystitis, cystitis tuberculosa or prostate hypertrophy. In those six cases, no marked abnormality was observed by IVP, cystogram, and arteriogram. And no tumour was found even by bimanual palpation nnder lumbar anesthesia. The cystoscopical diagnosis was not available for these cases. The highly malignant cancer cells were detected by the cytological examination of pumping method and then biopsy gave the correct diagnosis of the high grade transitional cell cancer. Any tumour was not found macroscroscopically on the surface of the bladder after radical cystectomy. But the histological study on the preparations of whole area of the cystectomized bladders revealed that considerable part of the mucosa was invaded by cancer and tumour embolisms occured in the blood and lymph vessels. Cancer cells infiltrated not so far, the stage being mostly stage 0 or stage A. On the other hand, the lymph node metastases were often observed around the bladder. We studied its chromosomal patterns in four cases and found abnormal chromosomes in all cases.
Usually, the diagnosis of bladder cancer is relied on the cystoscope, and the therapeutic indication is dicided on the basis of the infiltration. However, as the matter of fact, this criteria does not apply to some cases of bllader cancer; for these cases, cytological examination and biopsy are indispensable.
For these cases, even if they are low stage cancers, the palliative operations are improper, and the radical cystectomy combined with strong chemotherapy or radiotherapy are required.