Ureteral endometriosis: a case report and a review of the Japanese literature

Abstract

42歳, 女.腹部膨満感にて受診.検尿上, 顕微鏡学的血尿を認め, 血中CA125は軽度高値を示した.腹部CT検査では左水腎症と子宮に隣接する巨大腫瘤を認め, 逆行性腎盂造影では左下部尿管に陰影欠損を認めた.子宮筋腫及び左尿管腫瘍の診断から右附属器及び子宮摘除術と尿管部分切除術を施行.組織学的に左尿管腫瘤は粘膜下に存在する外性子宮内膜症であった.1971年以来本邦では104例が報告され, 術前診断は37.5%と, 悪性腫瘍との鑑別が困難な症例も少なくない.腎保存術も62.4%で施行され, 術後腎機能も良好な症例もみられる.尿路も視野に入れた各種検査と妊孕性を考慮した治療法の選択が望まれる

A 42-year-old woman was referred to our hospital because of abdominal fullness and a large abdominal mass. Computed tomography (CT) demonstrated bilateral ovarian tumors, uterine myoma and left hydronephrosis. On excretory urography the left kidney was not visualized and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the left lower ureter. Based on the diagnoses of endometriosis of bilateral ovaries, uterine myoma and a left ureteral tumor, abdominal total hysterectomy, right salpingo-oophorectomy and partial ureterectomy were performed. Pathologically, in the uterus, both leiomyoma and adenomyosis, and endometriosis of the right ovary and ureter were diagnosed. Medication with buserelin acetate was started.