腸閉塞を繰り返した尿膜管黄色肉芽腫の1例

Abstract

68歳男.悪性腫瘍との鑑別が困難で, 腸閉塞を繰り返した尿膜管黄色肉芽腫例である.腫瘤の存在部位の診断に腹部超音波パノラマ像が有用であった.化膿性尿膜管膿瘍, 膀胱黄色肉芽腫として報告されている症例にもよく似た病態を認めるが, 本例は腹部超音波検査で充実性腫瘤を認め臍・膀胱頂部方向に索状物が連続しており, 膀胱内には異常所見を認めず典型的な尿膜管黄色肉芽腫であった.本例は炎症性黄色肉芽腫と思われるが, 組織学的に悪性の経過をとる腫瘍性病変と鑑別が困難であり長期の経過観察が必要である

A 68-year-old male was admitted to our hospital with the chief complaints of lower abdominal pain and fever. There was a tender mass palpable in the lower abdomen. Plain abdominal X-ray film revealed multiple air-fluid levels with dilated small bowel loops, suggesting intestinal obstruction. Abdominal ultrasonography, computed tomography and magnetic resonance imaging revealed a solid mass extending from umbilicus to the bladder dome beneath the rectal muscle. There was normal mucosa of the bladder by cystoscopic examination. A urachal tumor was clinically suspected and en bloc removal of the mass, the remaining urachus, umbilicus, omentum and bladder dome was performed. The histological diagnosis was urachal xanthogranuloma. The patient has remained in good health without any recurrence for 6 months since the surgery. We discuss urachal xanthogranuloma in the literature.