放線菌による尿膜管膿瘍の1例

A CASE OF URACHAL ABSCESS MIMICKING URACHAL TUMOR

　62歳，女性。下腹部腫瘤を主訴に受診した。下腹部に手拳大，弾性硬の腫瘤を触れ，US,CT，MRIにて臍部から膀胱頂部へ続く腫瘤があり，尿膜管腫瘍が疑われた。臍・尿膜管・膀胱頂部を含むen bloc resectionを施行し，病理組織所見は放線菌による尿膜管膿瘍であった。尿膜管放線菌症は稀な疾患ではあるが，膿瘍の周囲に著明な線維化を伴うため悪性腫瘍との鑑別が困難で，特に尿膜管癌との鑑別に際して注意を要する疾患と思われた。

A 62-year-old woman complained of an abdominal mass. A round, hard mass with a diamater of Ca. 7 cm was found in the lower abdomen. On admission, WBC, ESR, and CRP were slightly elevated. The patient was clinically diagnosed using ultrasonography, IVP, CT scan and MRI as having a tumor in the urachal remnants. An ultrasonically guided percutaneous needle biopsy could not demonstrate malignancy. En bloc resection including the tumor, umbilicus and parts of rectus muscle and the urinary bladder was performed under general anesthesia. Pathological diagnosis was chronic granulomatous inflammation with actinomycosis.