尿管に発生したポリープの症例

Abstract

Chronic irritation on the urothelium, may it be inflammatory or mechanical, causes polypous or papillomatous proliferation of the epithelium. As mechanical one, urinary calculus plays an important role. This fact was proved in Japon by Tsuji et al. experimentally. Kato has found 4 cases of polypous proliferation out of 50 cases of renal stone (8 % incidence). Hino pointed out that inflammatory tumor of the ureter could be found in 6.6 % of ureterolithotomized cases. In this paper, 5 cases of polypous vegetatio n of the renal pelvis or ureter growing around the calculus and one case of polyp in sigmoid colon arising from the ureterosigmoidostomized ureteral stump were presented. Case 1. 38 year-old, male. A stone of finger-tip s ize was found incarcerated in the intramuscular portion of the right ureter, accompanied by several rod-like vegetations growing at the tip of right ureteral orifice and hanging into the bladder (Fig. 1). The stone was removed and the polyps (rod-like vegetations) were resected (Fig. 2). Histology revealed the polyps to be of inflammatory granulomatous vegetations (Fig. 3). Case 2. 30 year-old, male. A stone of finger-tip size was situated at right ureteral end. On ureterogram, irregular shadow defect was found closely above the stone (Fig. 4). On operation several polypous or papillomatous growths, 1-2mm x 5-6mm in size, were found around the stone. Histology revealed them to be fibrous polyps containing many capillaries with stroma (Fig. 5). Ca s e 3. 37 year-old, male. A bean-sized stone w a s situated at lumbar part of the left ureter. On operation, several polypous vegetations were found about the stone which were removed together (Fig. 6). They were proved to be polyps histologically (Fig. 7). Case 4. 34 year-old, male. A thumb-tip-sized ren a l pelvic stone associated with some ricecorn-sized polypous vegetations was recognized on operation. Histology revealed them to be inflammatory granuloma (Fig. 8). Case 5. 46 y e a r-old, male. In this case, ureterogram showed irregullar shadow defects both above and under the stone (Fig. 9), which lie in the middle of the right ureter. Small polyps were resected. and stone removed by operation. Histology proved them to be granulomatous fibrous tissues (Fig. 10). Case 6. 4 4 year-old, female. Nine years ago, the p atient was hysterectomized because of uterus myoma, followed by right uretero-vaginal-fistula, which was treated by ureterosigmoidostomy. About 8 years after the operation, bloody discharge was noticed from her anus, and it continued for about a year. A malignant tumor of the sigmoid was suspected. On operation, a thumb-tip-sized papillomatous or polypous growth arising from the ureterosigmoidostomized ureteral stump was observed (Fig. 11, P). The tip of the growth was tricephalic. Histological findings showed it to be an old granulomatous vegetation covered with colonic epithelium (Fig. 12). On l y 11 cases of polypous vegetation of the renal pelvic and, ureteral epithelium, and 8 other cases associated with stones have been reported up to date in Japan. In the case of long-standing stone, one should consider the exsistence of polyp, whenever free drainage of the ureter could not be obtained by ureterolithotomy alone.