機能的単腎患者に発生した尿管扁平上皮癌に対し尿管部分切除術を施行した1例

Abstract

60歳女.高度の腎機能低下により, CT, 腹部超音波検査を施行し, 右水腎症, 左萎縮腎と診断された.右逆行性腎盂造影を試みたが, 尿管カテーテルは挿入不能で, 経皮的腎瘻を造設し順行性腎盂造影を施行したところ, 下部尿管に約2cmにわたる完全閉塞部を認めた.そこで右尿管部分切除・尿管端々吻合術を施行した.切除尿管は組織学的には, 粘膜から周囲脂肪組織内まで腫瘍細胞を認め, 広い細胞間隙や癌真珠の存在から, 扁平上皮癌grade 2, INFβ, pT3, pR0, pL1, pV1と診断した

We report a case of squamous cell carcinoma of ureter. A 60-year-old female was referred to our hospital for the right hydronephrosis and the left atrophic kidney. She had been suffering from severe renal dysfunction and had hemodialysis a month earlier. Retrograde and antegrade right pyelography revealed complete obstruction of the right lower ureter about 2 cm in length. Transcutaneous retrograde left pyelography revealed vesicoureteral junction stenosis. After improvement of the renal function by transcutaneous right nephrostomy, the patient underwent right partial ureterectomy. Pathological examination revealed squamous cell carcinoma, grade 2, pT3 in the right ureter. Neither local recurrence nor distant metastasis has occurred for 19 months and the patient retains moderate renal function. We reviewed sixty-four cases of ureteral squamous cell carcinoma in the Japanese literature and discussed the renal parenchymal sparing surgery for the disease.