膀胱全摘, 直腸膀胱造設後11年目に発生した尿管癌の1例

Abstract

74歳男.膀胱全摘除, 直腸膀胱造設術を施行した.1年後に尿路感染症が疑われ受診した.白血球増多と貧血, 低蛋白血症とBUNの上昇, CRPの高値から右腎盂腎炎の疑いで入院した.右上部尿管L4の高さで造影剤の途絶を認め, 通過を妨げる病変の存在が示唆された.尿細胞診はClass II, CTでは右尿管の狭窄部に(軽度enhancementを受ける)2mm大のmassを認め, 画像より尿路腫瘍と診断された.全身麻酔下で経腹膜的に右腎尿管全摘除術を施行した.自験例では排尿は排便と同時に行われるため, 診断・検査で細胞検査も含め, 尿検査も容易でなくRPなど逆行性尿路検査が行えない中での診断にはIVP, AP, CTが有用であった

We report a 74-year-old male who developed ureteral carcinoma after 11 years of radical cystectomy and rectal bladder reconstruction. The patient had right lumbago and high grade fever and right hydronephrosis. He was suspected to have right ureter tumor under the antegrade pyelography at the time of right nephrostomy, and ureter tumor was diagnosed by the combination of computed tomography and antegrade pyelography. Under this preoperative diagnosis, right nephroureterectomy was performed. The histopathological diagnosis was transitional cell carcinoma. Since the recurrence of urothelial cancer at 10 years after radical cystectomy is rare, we believe our case is useful for the establishment of long-term follow up of bladder cancer.