直腸原発転移性尿管腫瘍

METASTATIC URETERAL TUMOR RESULTING FROM RECTAL CARCINOMA

　45歳，女性。左側腹部痛，下腹部不快感を主訴に来院した。尿管腫瘍として左腎尿管全摘除術を行い，術中，腫瘍と周囲臓器との連続性がないことを確認した。摘出標本では非乳頭状の腫瘍が認められ，組織学的に高分化型腺癌細胞が尿管の粘膜下層，筋層，外膜の血管内に認められた。術後直腸に原発巣が確認され，組織所見と合わせて転移性尿管腫瘍と診断した。癌性悪液質が次第に進行し，左側腹部痛出現から約5カ月後に死亡した。

A 45-year-old woman was admitted to our hospital with the chief complaints of left flank pain and lower abdonimal discomfort. Because retrograde pyelography showed obstruction at the middle third of the ureter, left total nephroureterectomy was performed as a primary ureteral tumor. Pathological findings were well differentiated adenocarcinoma which invaded the submucosa. muscle layer and adven-titia of the ureter. with malignant cells present inside the vessels of ureteral wall. The ureteral mucosa was intact from the tumor invasion.