完全重複尿管に発生した尿管癌の1例

Abstract

66歳男.左腰背部痛が増強し, 左尿管腫瘍, 膀胱腫瘍, 左重複腎盂尿管を指摘された.排泄性腎盂造影で左上半腎所属尿管は描出されず, 左下半腎所属尿管は軽度拡張し, 膀胱左側に陰影欠損像を認めた.膀胱鏡で左尿管口を1個確認し, その頭側に径3cmの有茎性乳頭状腫瘍を認めた.この腫瘍を経尿道的に切除したところ, 切除部に尿管口を認めた.病理所見で, 核が大型化した異型性の強いN/C比の大きな腫瘍細胞を粘膜上皮内に認めたが, 膀胱固有筋層への浸潤はなく, 移行上皮癌, grade 2, pTaと診断した.1週後に左腎尿管全摘除術及び膀胱部分切除術を施行した.上半腎所属中部尿管に3.0×3.5cmの白色調の非乳頭状広基性腫瘍を認めた.病理所見で核異型の強い悪性細胞が尿管固有筋層を越えて浸潤し, 移行上皮癌, grade 3, pT3であった.術後18ヵ月目に腹部CTで大動脈分岐部に50×40mmの腫瘤を認め, 再発と診断した.切除不能で化学療法を施行し, 術後22ヵ月で生存中である

A 66-year-old man presented at our hospital with left back pain. Intravenous pyelography, computerized tomography and magnetic resonance imaging revealed ureteral tumors of the complete left double renal pelvis and the ureter. An endoscopic examination disclosed a papillary tumor from the left ureteral orifice of the lower pole of the kidney. A transurethral resection of the tumor was done, and the pathological features revealed transitional cell carcinoma (PTa, grade 2). A left nephroureterectomy and a partial cystectomy were also carried out; macroscopic examinations showed a non-papillary tumor on the middle portion of the left ureter originating from the upper pole of the kidney. Microscopic examinations revealed transitional cell carcinoma (PT3, grade 3, PL1, PV1). Adjuvant chemotherapy (M-VAC) was administered but discontinued because of severe side effects. Dispite recurrence with retro-peritoneal lymph node metastasis, the patient is alive and again undergoing M-VAC chemotherapy 22 months after the initial surgery. However, the evaluation of the chemotherapy was "no change".