ベリニ管癌の1例

Abstract

70歳男.主訴は左背部痛, 肉眼的血尿.両側尿管カテーテル尿は左右ともclass IIIであった.腹部CT上, 明らかな異常所見は認めなかったが, MRIでは左腎臓上極に内部構造の不均一な部位を認めた.細胞診はclass II(右腎盂尿), III(左腎盂尿)であった.肉眼的血尿が強くなり, 膀胱鏡にて左尿管口から凝血魂を認めたため, 左尿管鏡下腎盂粘膜生検を施行した.病理学的に移行上皮癌が疑われ, 腎盂尿でもclass Vであった.左腎盂腫瘍の診断にて左腎尿管全摘術を施行した.病理学的所見で腫瘍細胞は集合管に沿って進展しており, 一部は腎周囲脂肪織まで浸潤していた.免疫染色では遠位尿細管系のマーカーであるPNA, E-cadherinは陽性で, 一方, 近位尿細管系のマーカーであるLTA, N-cadherinは陰性であった.以上より, ベリニ管癌と考えられた.術後追加補助療法は施行せず, 術後9ヵ月の現在, 再発を認めない

A case of Bellini duct carcinoma is reported. A 70-year-old man visited our hospital because of gross hematuria and left flank pain. Although no abnormality was found on ultrasonography, drip infusion pyecography, computed tomographic scan and cystoscopy. However class IV was suspected based on urinary cytology. Magnetic resonance imaging showed an irregular pattern in the left upper kidney. Ureterscopic biopsy revealed transitional cell carcinoma and class V was suspected on the urinary cytology of the left renal pelvis. Under the preoperative diagnosis of a left renal pelvic tumor, left nephroureterectomy was performed. The histopathological diagnosis with immunohistostaining was Bellini duct carcinoma. No evidence of recurrence or metastasis was noted 9 months after surgery without any adjuvant therapy.