後腹膜に発生した炎症性偽腫瘍(黄色肉芽腫)の1例

Abstract

左側腹部痛及び血清クレアチニン軽増で入院した57歳男で, 経静脈性及び逆行性尿路造影で左水腎症及び左下部尿管の外因性狭窄を認めた.CT及びMRIは両側下部尿管に沿う腫瘤を描出し, その左側は5×3×4cmであった.外科的診査及び腫瘍生検後, 黄色肉芽腫性炎症性偽腫瘍と診断された.悪性所見はなかった.開腹術後2週間に腫瘍の大きさは最初の20%に自然に縮小した.発症後3年に水腎症は改善し, 腎盂腫瘍は殆ど縮小した

A 57-year-old male patient was admitted to our hospital for left flank pain and a slight increase in serum creatinine. He had left hydronephrosis and extrinsic stenosis of left lower ureter shown by intravenous and retrograde pyelography. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a mass along the bilateral lower ureters, the left side of which was larger (5 x 3 x 4 cm). After surgical exploration and biopsy of the tumor the patient was diagnosed as having xanthogranulomatous inflammatory pseudotumor. No malignant findings were observed. Tumor size spontaneously decreased to 20% of the original size at 2 weeks after laparotomy. The patient underwent ureterolysis because of prolonged left hydronephrosis. Approximately 3 years after development of disease, hydronephrosis has improved and the pelvic tumor has almost diminished.