尿管に発生した炎症性偽腫瘍の1例

Abstract

28歳女.患者は右腰背部痛, 発熱を主訴とした.超音波断層, CTにて右水腎症と尿管下部に腫瘤を認めた, 腫瘤は良性の骨盤内腫瘤と診断され, セカンドオピニオンを求め受診した.逆行性腎盂造影(RP), 尿管鏡を施行したところ, RPでは下部尿管に辺縁整な陰影欠損を認めた.右尿管部分切除術を行い, 術中迅速病理診断にて炎症性偽腫瘍と診断された.尿管膀胱新吻合術を施行したことで, 腎尿管全摘除術を回避し, 上部尿路を温存することができた.病理ではリンパ球, 形質細胞などの慢性炎症細胞浸潤が主体の腫瘤であった.免疫染色でも悪性リンパ腫を示唆する所見を認めず, 尿管に発生した炎症性偽腫瘍と診断した

The patient was a 28-year-old woman. In February 2002, she visited another physician due to acute pyelonephritis. Based on CT findings, a lower ureteral stricture caused by a benign extraureteral tumor was diagnosed. The patient was being monitored by periodic exchange of ureteral stents. In February 2003, the patient visited our department seeking a second opinion. Retrograde pyelography showed an elliptical filling defect in the lower urinary tract. Ureteroscopy showed that the surface of the tumor was mostly smooth, regular and partially papillary. Biopsy was performed, and histological analysis revealed only nonspecific inflammation. In December 2003, based on a diagnosis of benign ureteral tumor, we performed partial resection of the right urinary tract and ureterocystoneostomy. As rapid intraoperative pathological analysis confirmed an inflammatory pseudotumor, total nephroureterectomy was avoided.