移行上皮癌と粘液癌とが混在した原発性尿管癌の1例

Abstract

79歳女。右下腹部痛を主訴に受診し、CTで回盲部に径5cmの腫瘍と右水腎症を認めた。また、他院泌尿器科にて右膿腎症のため右腎瘻造設術を施行し、順行性腎盂造影でL5/S1付近に陰影欠損像を認めた。尿細胞診はclassV、TCCで腫瘍は急速に増大し周囲の浸潤も疑い精査加療で紹介入院となった。右下腹部に小児頭大の腫瘤を触知し、入院後5日目より下腿浮腫が出現し、その後胸腹水が急速に出現しCTより腫瘍径は18cmと増大して腹壁への播種巣の増大も認めた。全身状態より手術が困難なため対症療法を行ったが腫瘍は増大し症状自覚から42日目に死亡した。剖検より粘膜を含む腫瘍は尿管壁外へ浸潤し、腹腔内の癒着は高度で腸管や腎盂に浸潤していた。病理所見より、粘膜癌が移行上皮癌より優位なG2、pT4で親和性をもって混在する像を認め尿管原発の粘液癌と診断した。

We present a case of primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma. A 79-year-old woman visited her home doctor with the chief complaint of right lower abdominal pain. Abdominal computed tomographic scan (CT) disclosed a tumor measuring about 5 cm in diameter at the right lower quadrant of the abdomen. Percutaneous nephrostomy was performed for hydronephrosis and pyonephrosis. The urinary cytology revealed class V, transitional cell carcinoma. Re-abdominal CT showed further enlargement of tumor diameter, but the primary site of the tumor was not identified. Her general condition worsened, and she died 42 days after her initial complaint. Pathologic examinations upon autopsy revealed both mucinous carcinoma and transitional cell carcinoma in the right ureter. Pathogenesis and management of this rare condition are discussed.