日本住血吸虫症による後腹膜線維症の1例  [in Japanese] RETROPERITONEAL FIBROSIS DUE TO SCHISTOSOMA JAPONICUM : A CASE REPORT  [in Japanese]

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Abstract

我々は,尿路上皮悪性腫瘍の治療を契機に発見された,日本住血吸虫が原因と考えられる後腹膜線維症の1例を経験したので報告する.<br> 症例は83歳男性で,腎後性腎不全の精査中に後腹膜線維症を指摘された.経皮的腎瘻造設術およびステロイドパルス療法で軽快したが,経過観察中に膀胱癌および上部尿路上皮癌が発見された.尿路上皮癌に対する外科的治療中に後腹膜線維組織の生検を行ったところ,後腹膜の繊維性組織内に散在する楕円形の石灰化した日本住血吸虫の虫卵を認めたため,本症例では日本住血吸虫が後腹膜線維症の原因であると判断した.<br> 日本住血吸虫が原因と考えられる後腹膜線維症は,非常に稀な病態であると考えられた.後腹膜組織に日本住血吸虫の虫卵が到達した機序としては,(1)血行性に虫卵が後腹膜腔へ到達,(2)血行性に成虫が後腹膜組織に到達し産卵,(3)消化管壁内の虫卵が何らかの原因で後腹膜へと逸脱,などが挙げられるが,我々は(3)の可能性が高いと考えている.住血吸虫症と悪性腫瘍の関係は以前から知られているが,日本住血吸虫症が原因と考えられる尿路上皮癌の報告例はなく,本症例の尿路上皮癌組織内に虫卵を認めなかったため,両者に因果関係がある可能性は低いと思われる.我々の知見では,日本住血吸虫が原因と考えられる後腹膜線維症の報告はなく,非常に稀な症例を経験した.<br>

We report a case of retroperitoneal fibrosis due to <i>Schistosoma Japonicum</i> in patient with urothelial carcinoma. Retroperitoneal fibrosis was observed in a-83-year-old man during examinations for postrenal renal failure. The symptoms were improved by percutaneous nephrostomy and pulse therapy using corticosteroids, however, urothelial carcinoma was detected during follow-up examinations. The biopsy of retroperitoneal tissue was performed during the surgery for urothelial carcinoma. The histopathological examination revealed scattered calcified eggs of <i>Schistosoma Japonicum</i> in retroperitoneal fibrosis tissue. Therefore, in this case, we assumed <i>Schistosoma Japonicum</i> was the cause of retroperitoneal fibrosis. In our knowledge, there is no report about retroperitoneal fibrosis due to <i>Schistosoma Japonicum</i>. We hypothesize the pathway that the eggs penetrate into retroperitoneal space is extravasation from intestinal wall and peritoneal cavity, although the detail of this mechanism is not obvious. It is well known about the relationship between Schistosomasis and malignant tumors. However, it seemed no evidence regarding the relationship between <i>Schistosoma Japonicum</i> and urothelial carcinoma, since there is no report about it and the eggs were not found in specimen of urothelial carcinoma.<br>

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 101(5), 694-697, 2010-07-20

    The Japanese Urological Association

References:  7

Codes

  • NII Article ID (NAID)
    110007682275
  • NII NACSIS-CAT ID (NCID)
    AN00196577
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    00215287
  • NDL Article ID
    10753965
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-203
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
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