著明な膀胱壁肥厚を伴った特発性後腹膜線維化症の1例

Abstract

49歳男.右下肢浮腫を主訴とした.DIPでは右腎盂・尿管は描出されず, 膀胱内腔は右側より圧排されていた.膀胱鏡にて膀胱頸部から右壁にかけて広範に隆起製病変を認め, 腹部CTでは右総腸骨動脈周囲から膀胱右側腔にかけて連続した軟部陰影を認め, 膀胱壁は右側を中心に著明に肥厚していた.腰椎麻酔下に経腹的・経直腸的針生検を施行した結果, 膀胱筋層, 周囲組織共に線維芽細胞, 膠原線維の増生を認め, 一部に巣状の炎症細胞浸潤を伴っていた.悪性所見を認めず, 特発性後腹膜線維化症と診断し, プレドニゾロン投与にて浮腫および画像所見は改善した

The patient was a 49-year-old male with the chief complaint of right lower extremity edema. Ultrasonography showed a right hydronephrosis and a thickening of the right side of bladder wall. No bladder tumor was found by cystoscopy. The right renal pelvis and ureter were not visualized by drip infusion pyelography (DIP). Computed tomography (CT) demonstrated a soft tissue mass surrounding the bilateral common iliac artery and extending to thickened bladder wall. After the echo-guided needle biopsy, steroid therapy was performed under the diagnosis of the idiopathic retroperitoneal fibrosis. Prednisolone was administered for 10 weeks, resulting in the complete disappearance of thickening of the bladder wall.