尿管原発悪性リンパ腫の1例

Abstract

71歳男.無症候性肉眼的血尿を主訴とした.経静脈的腎盂造影で右尿管・腎盂の軽度拡張を認めた.逆行性腎盂造影で右中部尿管に辺縁平滑な約2cm大の陰影欠損像を認めた.腹部CTで右尿管内に軽度造影効果を示す腫瘤を認めた.これらの所見から右尿管腫瘍を疑い, 手術を施行した.腫瘍は正常粘膜に覆われた隆起性病変であり, 術中迅速病理診断で悪性リンパ腫が強く疑われた.尿管部分切除+尿管尿管吻合術を施行し, 切除標本の病理組織所見からB cell Follicular center lymphomaと診断した

We report a case of malignant lymphoma (ML) of the ureter. A 71-year-old man was admitted to our hospital with the chief complaint of macroscopic hematuria. IVP showed the dilation of left ureter and renal pelvis. Retrograde pyelography showed a 2cm filling defect in the right middle ureter. From the data given, a right ureteral tumor was suspected, and we performed tumor biopsy under an ureteral scope. Since it was diagnosed not as transitional cell carcinoma (TCC) of ureter but as ML with strong inflammation, partial ureterectomy and uretero-uretero anastomosis were done. Histological diagnosis was B cell follicular center lymphoma. Because Ga-scintigraphy revealed no evidence of other involement, it was diagnosed as ML originating from ureter. ML secondarily invading the urinary tract organs is commonly found, but ML originating from the urinary tract is rare. Especially, in regards to ML originating from ureter, only 16 cases have been reported in Japan.