左腎盂癌を伴った膀胱原発Mucosa-associated lymphoid tissue(MALT)リンパ腫の1例

Abstract

84歳女。左腎盂腫瘍の精査目的で当科受診した。顕微鏡的血尿および膿尿を認め, 尿細胞診classV, Escherichia coli陽性であった。IVPにて左腎盂および膀胱に陰影欠損を認めCTにて左腎盂に径3×4cm大腫瘍を膀胱左壁に3×2.4cm大, 右側壁に2.2×1.2cm大の腫瘍を認め, 膀胱鏡では右側壁, 左後壁に非乳頭状基性腫瘍を確認した。根治的切除を目的としてTUR-BTを施行し同時に左壁内尿管を尿管口とともに切除し2週間後, 用手補助後腹膜鏡下左腎尿管全摘除術を施行した。病理所見より, 膀胱腫瘍LCA陽性, B細胞マーカー陽性で腫瘍基部は腫瘍の細胞を認めず, 腎盂癌はurothelial carcinoma, adenocarcinoma, Pt2, G2で左腎盂癌を伴った膀胱原発MALTリンパ腫と診断した。膀胱内に腫瘍が多発しており術後治療として膀胱部へ計36Gyの放射腺照射を追加し終了後14ヵ月経過して再発, 転移を認めていない。

We report a case of primary mucosa-associated lympoid tissue (MALT) lymphoma of the urinary bladder associated with left renal pelvic carcinoma. A 84-year-old woman showed microscopic hematuria during follow up for hypertention. Left renal pelvic tumor was found and she was referred to our hospital for further evaluation and managemant. She showed pyuria and Escherichia coli was detected by urine culture. Intravenous pyelography and computed tomography revealed the left renal pelvic tumor and solid bladder tumor. Transurethral resection of bladder tumor and left total nephroureterectomy were performed. Histologically, the left renal pelvic tumor was urothelial carcinoma > > adenocarcinoma, G2, pT2 and the bladder tumor was MALT lymphoma. Ga-scintigraphy showed no hot uptake suspicious of metastatic lesion. Then, external beam radiotherapy (36 Gy) was performed to the urinary bladder. She has been alive for 14 months with neither renal pelvic tumor nor MALT lymphoma showing any evidence of disease progression.