尿管腫瘍との鑑別が困難であった腎・尿路結核

A Case of Urinary Tuberculosis Appearing as a Ureteral Tumor

　症例は44歳，男性。主訴は右腰背部痛。腹部超音波検査にて右水腎症を指摘され，当科受診。画像診断にて上腎杯が造影不良な右水腎症と右尿管上部および下部に狭窄を認めた。下部の尿管狭窄部の尿管鏡下生検にて，管腔様構造内にhyperchromaticな核をもつ細胞が索状に配列し，移行上皮癌を否定しえず，右腎尿管全摘除術を施行した。病理組織にて悪性所見は認められず，腎および尿管に結核性変化がみられ，腎・尿路結核と確診した。

A 44-year-old man with right hydronephrosis demonstratedby abdominal US,was referred to our hospital. Excretoryurography revealed stenotic changes at the upper and lowerportions of the right ureter, and the upper calyces of theright kidney were not seen. Urinary culture for acid-fastbacilli was negative. Histological findings of ureteral mucosalbiopsy using ureteroscope was highly suggestive of tran-sitional cell carcinoma, therefore right nephroureterectomywas performed. Histological examination, however, revealedtuberculosis of the urinary tract. Pathogenesis and manage-ment of this rare condition was discussed.