尿膜管腫瘍が疑われた尿膜管黄色肉芽腫の1例

Abstract

47歳女性.患者は発熱, 下腹部痛で婦人科を受診し, 経腟超音波で膀胱頂部に腫瘤を認め, MRI上にて尿膜管腫瘍を疑い今回入院となった.所見では, 腹部MRIで膀胱頂部に子宮腹側より腹直筋後面を臍まで連続する内部が嚢胞状の腫瘤を認め, T1強調で低信号, T2強調で高信号を示した.更に造影MRI T1強調横断像では著明な造影効果があり, これらより尿膜管腫瘍を疑い手術を施行した.腫瘤は臍と恥骨の中間に存在し, 大網, 子宮, 膀胱頂部と癒着していたが, 子宮を温存して腫瘤を含む尿膜管全摘出術と膀胱部分切除術を行なった.病理組織では大型で泡沫状の細胞質を有するfotmy cellの著しい集簇と周囲の非特異的炎症反応と線維化が認められ, 尿膜管上皮は認めなかったが, 一部に尿路上皮によりliningされ, ところにより平滑筋に囲まれた管状構造を認め, 尿膜管黄色肉芽腫と診断した

A 47-year-old female consulted our hospital with the chief complaints of lower abdominal pain and fever. There was a palpable mass in the lower abdomen. The patient had undergone oophorectomy by lower abdominal median incision. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) demonstrated a cystic mass above the bladder dome extending to the umbilicus, which was strongly suspected to be a urachal tumor. Enhanced T1 weighted MRI showed a mass enhanced by contrast media. Partial cystectomy with urachal resection was performed by lower abdominal median incision. The histological diagnosis was xanthogranuloma. This is the thirteenth case report of xanthogranuloma of the urachus in the Japanese literature.