限局性尿管アミロイドーシスの1例

Abstract

46歳女性.患者は左側腹部痛を主訴とした.DIPでは左水腎症を認め, CTでは下部尿管に腫瘤陰影が認められ, 上部は水腎症を呈していた.更にMRIでは左尿管壁の肥厚を認め, 逆行性腎盂造影では尿管口より3cmから内外腸骨動脈分岐部まで尿管壁の不整を認め, 同部の擦過細胞診はclass IIIでTCC suspectedであった.以上より, 左尿管腫瘍を疑い, 根治的左尿管全摘術および膀胱部分切除術を施行した.病理組織学的にALアミロイドーシスで, 胃・直腸生検や血清・尿中蛋白に異常はみられず, 限局性尿管原発アミロイドーシスと診断された.術後8ヵ月現在, 再発なく経過良好である

A 46-year-old female was referred to our hospital with a complaint of left flank pain. Ultrasongraphy and computed tomography demonstrated a left hydronephroureter due to stenosis with a ureteral mass in the left lower ureter. Retrograde pyelography revealed severe stricture of left lower ureter and brushing cytology showed papanicolaou class III. Ureteral tumor was suspected and left nephroureterectomy with partial cystectomy was performed. Histopathological diagnosis was amyloidosis of the left ureter. There was no evidence of secondary or systemic amyloidosis. Finally, we diagnosed her with localized amyloidosis of the left ureter. Localized amyloidosis of the ureter is a relatively rare condition, and this is the 55th case reported in the Japanese literature.