無形成腎および同側尿管異所開口を伴った前立腺癌の1例

Abstract

We report a case of prostate cancer and left ectopic ureter opening to seminal vesicle with left renal agenesis. A 62-year-old man was admitted to our hospital for treatment of prostate cancer with cyst formation. On the rectal examination, a cystic tumor was palpable on the left side of prostate. The left kidney was not detected by intravenous pyelography and ultrasonography. Magnetic resonance imaging revealed a retrovesical cystic lesion in the left side. Total prostatectomy and left ureterectomy were performed under the diagnosis of clinical T1cN0M0 prostate cancer and left ectopic ureter opening to seminal vesicle with left renal agenesis. The pathological findings showed well differentiated adenocarcinoma, Gleason score 3 + 3, and left ectopic ureter entering into the seminal vesicle and left renal agenesis. The patient was well 39 months after the total prostatectomy and left ureterectomy without evidence of recurrence. There have been no cases of the association of this urogenital anomaly, such as ectopic ureter opening to seminal vesicle with renal agenesis and prostate cancer and the combined management of both. Our case seems to be first case in the Japanese literature.

62歳男。PSA高値を指摘され、他院で経直腸的前立腺生検を受けた際、超音波で前立腺左側近傍に嚢胞性腫瘤を認めて紹介となった。画像所見で左腎尿管への造影剤の排泄を認めず、左腎あるいはその痕跡を示唆する所見を認めなかった。骨盤MRIで嚢状腫瘤は内部に出血または高粘稠な液体貯留が疑われた。また、嚢状腫瘤の頭側では連続した管腔状の組織を認め、嚢状腫瘤に異所開口する尿管と診断した。前医の前立腺精検結果 (well differentiated adenocarcinoma)等により、左無形成腎および精嚢への尿管異所開口を伴った前立腺癌と術前診断し、手術を施行した。術中所見は術前診断に一致し、開口部の精嚢は嚢腫様に腫大していた。左尿管を頭側に剥離していくと、尿管は総腸骨動静脈分岐部で盲端に終わっており、左腎は同定できなかった。術後経過は良好で、39ヵ月を経過する現在、再発転移は認めなかった。