尿管原発悪性リンパ腫の1例

Abstract

58歳男.健康診断で右水腎症を指摘され, 精査目的で受診した.腹部骨盤部造影CTにて腎盂の拡張と腎実質の萎縮を伴う右腎ならびに腰椎4番レベルに水尿管に続くsoft density massを認め, 右上部尿路の逆行性腎盂造影では中部尿管に充盈欠損像がみられた.また, 右分腎尿の細胞診では異形細胞を認め, ClassIIIb, 移行上皮癌の疑診であった.右尿管癌として右腎尿管全摘除, 膀胱部分切除術を施行し, 病理診断は非ホジキンリンパ腫, び漫性大細胞型B細胞性リンパ腫(WHO分類), 免疫芽球性リンパ腫, 高悪性度(Kiel分類)であり, 尿管原発悪性リンパ腫, 臨床病期IE期(Ann Arbor分類)と診断した.術後はPirarubicin, Cyclophosphamide, Vincristine, Prednisoloneによる多剤併用化学療法を行うも著しい血小板減少のために1コースで終了となり, 術後15ヵ月現在, 無再発で経過を観察している

A 58-year-old man who had right hydronephrosis pointed out by medical checkup visited our hospital. Computed tomography and retrograde pyelography revealed a soft tissue mass in the middle portion of the right ureter. Urine cytology specimen from the right ureter suggested transitional cell carcinoma. Under the diagnosis of right ureteral cancer, we performed right total nephro-ureterectomy, partial cystectomy. The histopathological examination showed non-Hodgkin lymphoma (large B-cell type) of the ureter. Our diagnosis was Clinical Stage IE of the Ann Arbor Classification. The patient received only the first course of systemic chemotherapy (THP-cop), because he suffered severe thrombocytopenia in the course of the chemotherapy. No recurrence was found for 15 months after operation, and at present he is disease-free.