尿管腔内を経て膀胱内へ増殖したS状結腸癌の1例

Abstract

69歳男.患者はS状結腸切除術の施行後, フォローアップの腹部CTおよび超音波検査で左水腎症を認めた.左尿管狭窄は尿管外部からの圧迫所見で, S状結腸癌の再発による狭窄と診断し, 左ダブルピッグカテーテルを留置した.以後, 3ヵ月ごとに交換し, 尿細胞診を施行したところ, 標本の背景に壊死細胞が多くみられ, 尿路上皮癌と診断された.膀胱鏡を施行したところ, 左尿管口より突出する乳頭状腫瘍を認め, 腹部CTで左尿管狭窄部より膀胱に連続する尿管内腫瘍が認められた.以上, これらの所見より, S状結腸の左尿管内浸潤と診断, その後, 患者は癌性腹膜炎を併発し死亡となった

A 69-year-old male was admitted to the hospital with the chief complaint of left hydronephrosis and diagnosed. A year ago, he underwent sidmoidectomy to cure sigmoid colon cancer diagnosed as stage IV. Ultrasonography (US) and computed tomography (CT) detected the compression of the ureter at its middle left due to the enlargement of the left iliac lymph node and hydronephrosis and hydroureter at the proximal to the compressed part. Then, a ureteral tumor was suspected and urinary cytology was class V. Cystoscopy detected a papillary tumor projecting from the left ureteral orifice. Because the histopathological manifestation by transurethral resection of bladder tumor and that by the sidmoidectomy were consistent, it was considered that sigmoid colon cancer spread to the urinary bladder via the left ureter. There have been only 4 reported cases of adenocarcinoma that multiplied in the ureter, and this is the fifth case report.