3D-CT cystoscopyが診断に有用であった膀胱炎症性偽腫瘍の1例

Abstract

38歳男.排尿時痛を主訴とした.尿細胞診はclass IIで, 腹部超音波, 膀胱鏡検査, CT, MRIにて膀胱頂部から前壁にかけて内腔に突出する腫瘤像を認めた.3D-CT cystoscopyではbridging-fold様の粘膜の連続性を認め, 粘膜下腫瘍が強く疑われた.確定診断のため腰椎麻酔下に膀胱鏡で観察しつつ, 腹部より超音波ガイド下で腫瘤部の膀胱全層生検を施行した.また, 一部をTURし病理組織診断に供した.病理診断はTCC疑いであった.膀胱部切除術および尿膜管摘除術を行い, 病理組織学的所見より膀胱炎症性偽腫瘍と診断した.術後経過は良好で, 術後約2年経過したが再発の徴候なく, 経過観察中である.自験例は調べ得た限りでは本邦20例目であった

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.