Periureteral inflammatory pseudotumorの1例

Abstract

59歳女.腰背部痛を主訴とした.初診時, 腹部CT及びMRIにて右尿管周囲に腫瘤を認めた.腫瘤は造影効果を認め, 尿管癌が疑われた.sIL-2Rの上昇が軽度であること, 全身の表在リンパ節を触知しないことより, 悪性リンパ腫の可能性は低いと考えられた.入院後, 右逆行性腎盂造影では腎杯の変形・拡張, 尿管の狭窄, 不整は認めず, 軽度腎盂が拡張しているのみであった.同時に採取した右腎盂尿細胞診もclass IIであった.そこで, 再度CTを施行したところ, 前回認めた腫瘤は縮小し, 水腎症も軽減していた.経過からinflammatory pseudotumor等の良性疾患が考えられた.患者希望により経過観察を行うこととし, 1～3ヵ月毎に腹部CTを行ったが腫瘍の増大を認めることは一度もなく, 経過と共に右腎盂および尿管壁の肥厚の軽減と周囲の腫瘤の著明な縮小を認めた.腎盂・尿管における本邦報告例は自験例を含め7例のみであった

A 59-year old female presented with right flank pain and hydronephrosis. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) before admission (August 2001), revealed a periureteral mass measuring 11 cm in length along the right ureter. Since the preoperative image examinations could not exclude a malignancy, she was admitted for surgery. After admission, however, she presented no abnormal findings in laboratory investigations including tumor markers, urinalysis, urine cytology and retrograde pyelography. C-reactive protein was normalized. CT after admission (September 2001), showed spontaneous regression of the mass. We cancelled the operation and decided to carefully watch this lesion by CT. The lesion continued to regress thereafter. Judging from the clinical course, we regard the mass as inflammatory pseudotumor although pathological diagnosis was not performed. The possibility of preserving the urinary tract in this disease is discussed by reviewing the previously reported inflammatory pseudotumor of the upper urinary tract.