抄録
症例は70歳,男性.肉眼的血尿,両側水腎症を主訴に受診した.膀胱鏡では,膀胱頚部に非乳頭状,広基性の腫瘍らしき組織が観察できた.CTでは両側水腎で,原因は下部尿管の狭窄によるものと思われた.膀胱と前立腺の境界部に,縦にのびる腫瘤状の組織がみられた.膀胱,直腸周囲には多量の脂肪が沈着し,膀胱は逆涙滴状に変形して腹側に偏位しており,骨盤脂肪腫症の所見であった.尿道膀胱造影では前立腺部尿道は延長し,膀胱は腹側に偏位していた.腰椎麻酔下に経尿道的腫瘤切除術を施行したところ,病理は増殖性膀胱炎の所見で悪性像は見られなかった.経会陰的膀胱頚部腫瘤生検にても,悪性所見はなかった.現在,柴苓湯,塩酸セチリジンから抗生剤と消炎酵素剤に治療を変更して,経過観察中である.
A 70-year-old man consulted our hospital complaining of gross hematuria and bilateral hydronephrosis. Cystoscopic findings suggested non-papillary sessile tumor at the bladder neck. CT findings revealed bilateral hydronephrosis caused by the stricture of lower ureters. Tumorous structure existed between bladder and prostate. Abundant fatty tissue was observed around bladder and rectum, the shape of the bladder was distorted to inverted tear-drop and the bladder was transferred anteriorly, showing findings of pelvic lipomatosis. Urethrocystography revealed elongation of prostatic urethra and anterior displacement of the bladder. Transurethral tumor resection was performed under spinal anesthesia. Pathological diagnosis was proliferative cystitis and no malignant cells were observed. Transperineal tumor biopsy also revealed no malignant cells. The patient was followed under administration of "Saireitou" (Chinese medicine) and cetirizine hydrochloride, followed by antibiotics and anti-inflammatory enzyme preparations.
