腎盂アミロイドーシスの1例

Abstract

74歳男で, 肉眼的血尿を主訴とした.逆行性腎盂造影検査で腎盂に突出する陰影が認められた.尿管鏡検査では, 腎盂から上部尿管にかけて粘膜の浮腫を伴った不整な肥厚と, 同部位からの数ヶ所の出血が認められた.同部位の分腎尿検査の結果はclass IIIa, 擦過細胞診はclass IIIb, TCC suspectedであった.これらの所見から腎盂腫瘍を強く疑い腎尿管全摘術を行ったが, 術後の病理組織診でeosinに淡染する無構造・硝子様物質の沈着を認め, 各種染色法によってアミロイドAL蛋白であることが判明したため, 本例をALアミロイドーシスと診断された

We report a case of localized amyloidosis of the renal pelvis and upper ureter arising in a 74-year-old man who presented at our hospital with gross hematuria. The intravenous pyelogram showed right hydronephrosis and stenosis of right renal pelvis and upper ureter. The cystoscopy view was normal, but the right retrograde-ureteropyelogram showed a long irregular stricture of the renal pelvis. Ureteroscopy was performed and rubbing biopsy of edematous, bleeding lesion suggested class IIIb, transitional cell carcinoma. With the diagnosis of a right renal pelvic tumor, right nephroureterectomy was performed. The histology report stated "massive deposits of amyloids are seen in the segment of macroscopically abnormal renal pelvis". Amyloidosis of the renal pelvis is a rare entity and 12 cases were reported in the Japanese and English literature.