血清CA19-9値が高値を示した尿管結石による膿腎症の1例

Abstract

71歳女.右側腹部痛の為に入院.画像診断の結果, 右尿管結石による水腎症及び水尿管症を認めた.血清CA19-9値は102.9U/mlと高値であったが, 肝・胆・膵・消化管及び婦人科臓器に異常陰影を認めなかった.尿路造影では右腎は機能しておらず, 右腎摘出術を施行した.組織学的には慢性炎症所見が認められ, 悪性の所見はなかった.術後にはCA19-9は24U/mlに低下した.免疫組織学的に, 尿管上皮にCA19-9抗原が認められた

A case of pyonephrosis with high levels of serum CA19-9 antigen is reported. A 71-year-old woman was admitted with right flank pain. Computed tomography and ultrasonography showed severe hydronephrosis and hydroureter due to a right ureter stone. Laboratory data revealed a high level of serum CA19-9. However, no tumor was found in the pancreas, gallbladder, liver, gastrointenstinal tract or genitourinary tract. Drip infusion pyelography showed a non-functioning pattern of right kidney. Therefore, right nephroureterectomy was performed for right pyonephrosis. Histological examination revealed chronic inflammation. Malignant cells were not seen in the resected specimen. The serum CA19-9 levels before and after operation were 102.9 U/ml and 24 U/ml, respectively, being normal after the operation. Immunohistochemical examination revealed the presence of CA19-9 antigen in the urethelium, indicating its expression in the specimen. To our knowledge this might be the first case of pyonephrosis associated with high levels of serum CA19-9 antigen.