尿路上皮癌との鑑別が困難であった尿路結核

Urinary tract tuberculosis presenting as urothelial cancer : A case report

　79歳女性．右水腎症精査目的に当科紹介受診．腹部CTで右腎盂尿管移行部狭窄を認めるも悪性所見に乏しく，経過観察を行っていたが，約1年後のCTにて右尿管の全周性壁肥厚と傍大動脈リンパ節腫大の出現を認め，尿細胞診はClassⅢであった．尿路上皮癌を否定できず，右腎尿管全摘除術を施行した．診断は尿路結核であり，イソニアジド，リファンピシン，エサンブトールの3剤併用による抗結核治療を9か月間施行したが再発を認めていない．

Abstract

A 79-year-old woman was referred to our hospital due to right hydronephrosis. Enhanced computed tomography (CT) showed the right pelvi-ureteric stenosis. Urine cytology was negative. Many leukocytes and a few Enterococcus faecalis were detected which was improved by antibiotics. Follow-up policy was taken because of no evidence of malignancy. However three months later, CT showed right ureter thickening and para-aortic lymph nodes swelling. The possibility of ureter cancer could not be ruled out and right nephroureterectomy was performed. The histopathological diagnosis was urinary tract tuberculosis and three drugs (isoniazid, rifampicin, ethambutol) were given for nine months. No recurrence was seen after the treatment (Rinsho Hinyokika 70 : 275-279, 2016).