炎症性偽性膀胱腫瘍を伴った神経因性膀胱の1例

Abstract

36歳女.2年前, 繰り返す膀胱炎と血尿を主訴に他院を受診し, 腹部CTで膀胱腫瘤を発見され経尿道的切除術を受けた.病理学的に膀胱肉腫を疑われたが最終的には炎症性偽性膀胱腫瘍と診断され保存的治療が行われた.その後, 尿失禁及び膀胱尿管逆流現象による頻回の腎盂腎炎を発症したため今回受診した.精査の結果, 神経因性膀胱の診断を得たが原因は不明であった

A 36-year-old woman was referred with urinary incontinence and recurrent episodes of pyelonephritis. Two years prior to her visit, she underwent transurethral resection of a bladder tumor, 5 cm in diameter. Total cystectomy was suggested, as the initial diagnosis was sarcoma. Close re-evaluation of the pathological specimen lead to the final diagnosis of a benign inflammatory pseudotumor of the bladder as the tumor consisted of smooth muscle cells with white blood cell infiltration but without mitotic figures. The tumor disappeared during the follow up period. A cystography revealed bilateral vesicoureteral reflux with marked trabeculated bladder. A cystometry showed loss of bladder sensation and a low compliance bladder without detrusor contraction. Neurological examination and a magnetic resonance imaging of the spinal cord failed to prove the presence of definite neurological abnormalities. She was finally diagnosed with neuropathic bladder of unknown origin. In this case, she had been suffering from recurrent cystitis about 6 years before the resection of bladder tumor and it was suggested that the occurrence of the inflammatory pseudotumor of bladder would be related with chronic urinary tract infection due to neuropathic bladder. Urinary incontinence and urinary tract infection were controlled successfully with clean intermittent self-catheterization and adequate administration of antimicrobial drugs. Vesicoureteral reflux was treated with injection of GAX collagen into the ureteral orifices. No tumor recurrence has been found up to the present time, 5 years after the resection of bladder tumor.