尿管部分切除を施行したIntrinsic type尿管エンドメトリオーシスの1例

Abstract

28歳女.下腹部痛が出現し, 痛みが改善しないため受診した.超音波検査で左水腎症を認め, DIP及び左逆行性腎盂尿管造影で左尿管腫瘍を疑い入院となった.悪性腫瘍も完全には否定できず, 内視鏡的には切除困難であり, 腎機能の保持等の理由で手術を施行した.病理組織検査では尿管粘膜下層及び筋層を中心に腺管構造を呈する子宮内膜組織を確認し, 尿管鏡所見及び術中所見と併せてintrinsic typeの尿管エンドメトリオーシスと診断した.術後10日目の超音波検査で左水腎症の改善を認め, 退院した.他部位のエンドメトリオーシス検索により, 新たに右卵巣子宮内膜症と診断, ホルモン療法を約半年行った.術後2年現在に至るまで再発を認めていない

We report a case of intrinsic-type ureteral endometriosis in a 28-year-old woman. She visited our hospital, complaining of lower abdominal pain. Drip infusion pyelography (DIP) showed left hydronephrosis, and left retrograde pyelography revealed a filling defect of the left pelvic ureter. Biopsy under ureteroscopy showed chronic ureteritis. It was difficult to exclude a malignant tumor, and we performed left partial ureterectomy and uretero-ureterostomy. The pathological examination showed endometrial tissue in the submucosal and muscle layer, and we diagnosed it as intrinsic-type ureteral endometriosis judging from the findings of the ureteroscopy and the operation. After the operation, drip infusion pyelography showed the improvement of the left hydronephrosis and ureteral passage, and the right ovarian endometriosis was found by gynecologists. She received hormonal therapy with the luteinizing hormone releasing hormone agonist for about half a year, but the right ovarian endometriosis remained unchanged. This is the ninth case in the Japanese literature reported as intrinsic-type ureteral endometriosis.