右無機能の馬蹄鉄腎に発生した高齢者の再発性尿管膀胱腫瘍に対し腎保存手術を施行した1例

Abstract

症例は79歳女で, 右無機能腎を伴った馬蹄鉄腎に発生した左尿管膀胱腫瘍例である.組織学的には移行上皮癌ではあるが, 尿管, 膀胱に生じた腫瘍であった.発生については, 家族歴では多くの癌患者を有し, 既往歴でも3重複癌の状態にあった.本症例は当院外科より異時性多発重複癌として報告されており, 今回の尿管膀胱移行上皮癌の発生で4重複癌となる.いずれの癌も偶発癌でなく, 臨床的に癌として診断され, 手術療法を受けている点が特徴的である.これまで2回尿管部分切除を行い, 腎機能を保存し, 尿路変向もせずQOLの保持目的は果されているとみられた

A 79-year-old woman was admitted with recurrent ureteral and bladder cancers. She had a horseshoe kidney with a non-functioning right renal unit. Fifteen months earlier, multiple urothelial tumors had first developed in the left upper ureter and bladder. Transurethral resection of bladder tumor (TUR-Bt) and partial ureterectomy (2 cm) had been performed. Presently, the recurrent tumors were located at the left lower ureter and bladder. Considering the high age of the patient, TUR-Bt and partial ureterectomy (5 cm) were performed. Besides urothelial cancers, she had been operated for carcinomas of the colon, uterus and stomach. Kidney-sparing therapy has successfully maintained her quality of life.