水腎症の精査を契機に発見された尿管・膀胱マラコプラキアの1例

Abstract

78歳女.水腎症の精査依頼を主訴とした.入院時, 血液検査, 尿検査, 尿培養に異常はみられず, DIPおよび腹部CTにて右水腎症と右尿管口付近の隆起性病変を認めた.膀胱鏡では, 三角部右側に小指頭大の黄白色の腫瘍を認め, 膀胱内のその他の部位にも黄白色の扁平な腫瘍が5～6個散在していた.三角部右側の腫瘍に対して経尿道的切除術を施行し, double J catheterを留置した.膀胱および尿管より採取された検体の病理組織では, 組織球様細胞の増生がみられ, 一部の細胞質内にMichaelis-Gutmann bodyを認め, 膀胱, 尿管のマラコプラキアと診断した.ST合剤, アスコルビン酸, 塩化ベタネコールの投与を開始したが, 薬剤性肝機能障害のためST合剤は中止した.その後, 膀胱鏡, 右尿管鏡で腫瘍の消失を認め, 尿管および尿管口の狭窄に伴う水腎症や膀胱尿管逆流現象は現在まで認めていない

We report a case of malacoplakia in the ureter and bladder. A 78-year-old woman was admitted to our department for detailed examination of hydronephrosis. A small-fingertip-sized tumorous yellowish white lesion was detected by cytoscopy at a site that appeared to be the right side of the ureteral orifice. Transurethral resection was performed on the same site. Flat yellowish white protruding lesions were seen at two sites on the right ureter. Michaelis-Gutmann bodies were observed in biopsy specimens from both the bladder and ureter, and a diagnosis of malacoplakia was made. Ascorbic acid and bethanechol chloride were administered postoperatively. Endoscopy performed three months after the operation showed that the protruding lesions in the bladder and ureter had disappeared. Narrowing of the ureter or vesicoureteral reflux has not been seen to date.