Ureteral tumor occurring from remaining stump: a case report

79歳男.無症候性肉眼的血尿を主訴とした.既往には, 27歳時に左腎結核による左腎摘除術があった.尿細胞診は陰性であったが, 膀胱鏡検査で左尿管口存在部に径2～3cmの非乳頭状有茎性腫瘍を認めた.経尿道的膀胱腫瘍切除術を行った.腫瘍は左尿管口より突出し, 移行上皮癌(G1≫G2, pTa)であった.術後の造影CT, MRI検査で左総腸骨動脈交差部以下の遺残尿管内に造影される腫瘍陰影を認めた.全身検索では明らかな転移巣は認められず, 残存尿管摘出術, 及び膀胱部分切除術を行った.切除尿管は18cm長で, 内腔には, 尿管口断端より上方5cmにわたり乳頭状広基性腫瘍がみられた.urothelial carcinoma(G2>G3, pT2, pNx, pMx, pR0, pL0, pV0)であった.術後補助療法を行わなかったが経過は順調で, 術後2ヵ月を経て, 明らかな再発, 転移の徴候はない
Primary tumor originated from ureteral stump following nephrectomy for benign disease is extremely rare. A 79-year-old male was referred to our department for asymptomatic macroscopic hematuria. He had undergone left simple nephrectomy for renal tuberculosis 52 years ago. Cystoscopic examination revealed a ureteral tumor on the residual ureteral orifice. Under the diagnosis of left ureteral stump tumor, which was subsequently enhanced on computer tomographic scan and magnetic resonance imaging, he received partial cystectomy and excision of the left ureteral stump. The histological examination revealed grade 2 to 3 urothelial carcinoma with muscle invasion (pT2). He received no adjuvant chemotherapy. He is now alive and free from recurrence 2 months post-operatively. This is the 21st case reported in the Japanese literature.