腟式子宮全摘除術8年後にみられた膀胱子宮内膜症

Endometriosis of urinary bladder：developing 8 years after total vaginal hysterectomy

　症例は46歳，女性。肉眼的血尿を主訴に来院した。38歳時に子宮筋腫に対する腟式子宮全摘除術の既往があった。膀胱後壁に非乳頭状広基性病変がみられ，MRIにて径2cmの腟壁に達する腫瘍病変を認めた。経尿道的生検にて診断が困難であり，膀胱部分切除術が施行された。病理組織検査にて膀胱子宮内膜症であった。

A 46-year-old,gravida 2,para 2,premenopausal woman presented with macroscopic hematuria. Eight years previously she underwent a total vaginal hysterectomy for uterine myoma. Cystoscopy revealed a sessile polypoid legion on the posterior bladder wall. Magnetic resonance imaging showed a 2cm heterogeneous mass on the posterior bladder wall,infiltrating to the anterior vaginal wall. Transurethral biopsy of the mass was performed,but was insufficient to obtain the pathological diagnosis. Subsequently partial cystectomy was performed and the final pathology report confirmed endometriosis of bladder. Endometriosis of the genito-urinary tract most frequently involves bladder,occurring 1 to 2 percent of cases and relatively rare after hysterectomy. We should keep it in mind that endometriosis of the urinary tract can eventually happen even in post-hysterectomy women.