尿管結紮により巨大水腎症を合併し術前診断が困難であった上部尿路上皮癌の1例

Abstract

A 73-year-old woman was referred to our hospital with a complaint of left lumbar backache. Computed tomography (CT) revealed left giant hydronephrosis containing high-density fluid suspected of hemorrhage in the renal pelvis and swelling of cervical and mediastinal lymph nodes. Positron emission tomography (PET)-CT showed a small high uptake lesion in the left kidney parenchyma, and cervical and mediastinal lymph nodes. Percutaneous pelvic puncture yielded discharge of hemorrhagic fluid with negative cytology. Preoperative diagnosis was left giant hydronephrosis due to ligation of a left ureter at uterine myomectomy 43 years ago with renal hemorrhage caused by recent back injury, and cervical and mediastinal lymph node involvement of unknown origin. Because severe lumbar backache persisted, we performed palliative left nephrectomy and biopsy of cervical lymph nodes. The pathological diagnosis was invasive urothelial carcinoma with squamous differentiation and lymph node involvement.