原発性尿管腺癌の1例: Primary adenocarcinoma of the ureter

The patient was a 66-year-old man who presented with asymptomatic hematuria. Left hydronephrosis was observed on drip infusion pyelography (DIP), and retrograde pyelography (RP) was performed because the image of the ureter was poor. On RP, stenosis was observed in the left ureter at the L5 vertebral level. The same findings were obtained by antegrade pyelography in combination with nephrostomy. A white-colored tumor was observed at the site ofstenosis by flexible pyeloscopy, and biopsy was performed. Adenocarcinoma was identified by histopathological examination. Total left renal nephroureterectomy was performed after its diagnosis as primary adenocarcinoma of the ureter (T2, NO, MO). To our knowledge, this is the 12th case reported in Japan.患者は66才, 男性。無症候性肉眼的血尿を主訴に受診, DIPでは左水腎症を認めたが尿管の抽出が不良であったため, retrograde pyelography(RP)を施行した。RPでは, 第5腰椎レベルで左尿管の狭窄を認め, 腎瘻増設を兼ねて行ったantegrade pyelographyではRPと同様に, 第5腰椎レベルで狭窄を示していた。同時に施行した軟性腎盂鏡では狭窄部位に一致して白色の腫瘍を認めたため, 生検を施行した。病理組織検査の結果はadenocarcinomaであった。原発性尿管腺癌(T2, N0, M0)の診断にて左腎尿管全摘除術を施行した。本症例はわれわれが調べえた限りでは本邦12例目であった。(著者抄録