尿管ポリープと鑑別困難であった内反型尿管移行上皮癌の1例

Abstract

59歳男.無症候性顕微鏡的血尿を主訴とした.DTPでは左中部尿管内にfilling defectを認め, 腹部CT scanでも同部位に尿管壁の肥厚が認められ, 逆行性尿管造影でも中部尿管に陰影欠損像が認められた.尿管鏡検査を施行し, 陰影欠損部は表面平滑, 可動性があり良性の尿管ポリープを疑う所見であった.内視鏡下生検および左分腎尿検査において病理組織学的検査は悪性所見を認めず, 細胞診もclass IIであった.しかし, 近医にて施行した左分腎尿細胞診の結果がclass Vと判明したため, 左尿管部分切除を施行した.術中迅速病理学的検査にてtransitional cell carcinoma(TCC)と診断されたため, 引き続き左腎尿管全摘術を施行した.最終病理診断は, TCC, grade II, pTaであった.術後1年6ヵ月の時点で再発はない

A 59-year-old man was admitted to our hospital in June 2001 for evaluation of an asymptomatic microscopic hematuria. One year prior to presentation, he had a spontaneous discharge of a left ureteral stone. Excretory urography and retrograde pyelography showed a filling defect in the middle portion of the left ureter. Cystoscopic examination did not reveal any abnormality, and urinary cytology was class I. Cold cup biopsy was performed under ureteroscopy, and pathology revealed inflammatory fibrovascular tissue but with no malignancy. Selective washing cytology was class III, whereas selective washing cytology done at the referring hospital was reported to be class V. Under a preoperative diagnosis of a left fibroepithelial ureteral polyp or a transitional cell carcinoma, left segmental ureterectomy was performed. The tumor was 5 x 5 x 5 mm in size, pedunculated, and smooth-surfaced. Intraoperative pathological examination of a frozen section showed an inverted type transitional cell carcinoma. Therefore, a left nephroureterectomy was performed, and the final histopathological examination confirmed an inverted type transitional cell carcinoma of grade 2. The patient is healthy and free of disease 15 months after operation. We also reviewed the current literature relating to transitional cell carcinomas of the ureter with inverted proliferation.