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a. .......................................................................................................................................... 4
b .................................................................................................................................. 4
c .............................................................................................................................. 4
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2 .............................................................................................. 5
3) ........................................................................................................................ 5
4) .................................................................................................................................... 5
5) ............................................................................................................................ 5
6) ............................................................................................................................ 5
d .............................................................................................................................. 6
e .......................................................................................................................... 7
f ................................................................................................................................... 7
g .................................................................................................................................. 7
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C.AP .........................................................................................10
D. ......................................................................................................................10
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A. ....................................................................................................................16
B: ......................................................................................................................17
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lymphoepithelioma-like carcinoma .....................................................27
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- 3 Copyright Noriharu mikata 2016 All Rights Reserved
1 1976 2006 1976 190 2006 2305 12.16 A
1996 5000 2008 7000 A
1976 5 15 1996 5 25 1993,1994 10 1.62 2.54 0.78
15
22 2225
0
5
10
15
20
25
2:
- 4 Copyright Noriharu mikata 2016 All Rights Reserved
.
a.
45% 5%
b
c
Akaza1987
1993
1994
1997
168 222 80 12
18 58 7 4
34 35 5 1
1 32 15 1
130 207 66 11
56 57 17 7
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3:
1: carcinoma in situ:CIS urothelial(trnsitional cell)carcinoma:UC squamous cell carcinoma:SCC adenocarcinoma :AC (1) (2) signet-ring cell carcinom clear cell carcinoma small cell carcinom a undifferentiated carcinoma
- 5 Copyright Noriharu mikata 2016 All Rights Reserved
1996 2003 (2004
396 89 61
7 2
3 1
17 6 3
3 1
1 1
1 4
0%
20%
40%
60%
80%
100%
7:
TCC: SCC: AC:
1
flat carcinoma in situ
2
3)
4)
(1)
(2)
5)
6)
90%
5-6% 1%
2004 9
- 6 Copyright Noriharu mikata 2016 All Rights Reserved
8:T
0%
20%
40%
60%
80%
100%
T4 50 84 42 7 24 4 4 10
T3 93 116 156 21 133 21 39 35
T2 82 69 78 7 64 12 15 11
T1 96 152 115 13 121 13 18 11
44 57 68 9 40 7 15 2
5 13 2 8 5 2
Akaza
1987
1993
1994
1995
1996
2002
2003
2004
d
TNM
TNM 6
T
N M
T
T3
T1
Bennington
Stage13
Stage10 Stage32 Stage
14 StageT3N0M0
2
2cm1
2cm5cm1
5cm
5cm
3:Beninton
no evidence of invasion
superficially invasive (limited tothe lamina propria) extending to the muscularis (intrarenal porsit ions of the renal pelvis) extending to the adventit ial surface,involving adjacent structures and/or metastatic
- 7 Copyright Noriharu mikata 2016 All Rights Reserved
9:G
0%
20%
40%
60%
80%
100%
28 28 71 15 7 1 7
115 182 146 26 154 35 39 40
186 272 294 29 196 24 52 21
73 58 40 5 59 3 6 1
Akaza
1987
1993
1994
1995
(1996
2002
2003
(2004
10:
1
21
6
1
1
4
1
1
1
2
2
0%
20%
40%
60%
80%
100%
2 2
1
1
4 1
1 1
6
2 1
1
1995[20) 2004[5)]
e
UICC G
G
G3 G4
f
5 3 1
g
8 11.6%
3,4
12 16%
- 8 Copyright Noriharu mikata 2016 All Rights Reserved
20-29 30-39 40-49 50-59 60-69 70-79 80-89 90
(%) 5 .8 17.4 27.5 26.1 14.5 1.5
(%) 0 .3 3.4 6.5 23.8 28.7 28.7 9.3 1.2
(%) 0. 16 0. 98 4.7 20.9 30.6 33.9 8.5 0. 16
Akaza(%) 0 .2 2.8 7 24.1 34.1 27.4 4.3
0
10
20
30
40
11:(%)
12:
0%
20%
40%
60%
80%
100%
13
7 4 4
30 34 263 304 112 337
39 28 205 240 78 257
2004
2002
1996
1994
(1994
(1994
13:
0%
20%
40%
60%
80%
100%
2
1 14 3 10 16
1
4 6 11 7
3 1 2 21
11 7 10 5 33
1 3 1 4
46 72 35 50 163
2004
2003
2002
1995
1994
20
90 60
70
Akaza
60 70
67.3
80-90
60%
5 48 21 2.3:1Akaza 9 350 110 3.1:1 24-27 223 101 2.2:1 10 462 149 3.1:1 18 48 14 3.4:1 17 379 172 2.2:1 20 50 25 2.0:1 6 355 120 3.0:1
4
- 9 Copyright Noriharu mikata 2016 All Rights Reserved
)
)
)
- 10 Copyright Noriharu mikata 2016 All Rights Reserved
)
goblet sign
C.AP
D.
- 11 Copyright Noriharu mikata 2016 All Rights Reserved
- 12 Copyright Noriharu mikata 2016 All Rights Reserved
25:(%)
30
40
50
60
70
80
90
Akaza(1987 73.6 67.5 60.3
1993 58.2 48 30.3
1994 57.5 41
2002 82.9 68.6
2003 78 70
2004 58.8 56.2 43.4
0102030405060708090
100
0 2000 4000 6000
26:
[]
[][]
60-70%
50%
58.8%56.2% 43.4%
Stage
- 13 Copyright Noriharu mikata 2016 All Rights Reserved
1
19782009 A 19982001,2004,20072010
39:491
495,1993
22:215218,1997.
57:11421144,1995.
1986 2000 17(2):167172,2004
58:925-931,1996
Kariba T.,Tsuchida H.,Muramatu H.,Kaneko S.,Iizumi T.,Toyoshima A.,Yazaki T.,Waku
M.:Renal pelvic transitional cell carcinoma associated with renal calculi:a case report Nishinihon
J.Urol.,50:1025-1028,1988
50:923-126,1988
Akaza H.,Koiso K.,Niijima T.:Clinical Evaluation of Urotherial Tumors of the Renal Pelvis
and Ureter Based on a New Classification System Cancer 59:1369-13751987
611 84:1839-1844,1993
56:38-42,1994
2002
43
2006.6.10
10 99
49:451-456,2003
95:725-728,2004
UICC:TNM clasification of malignant tumours. 6th ed., Sobin L.H.& Wittekind
Ch.ed.Willey-Lisss INC. New York,2002
56:610-615,1994
48:735-739,2002
Bennington J.L. and Beckwith J.B.:Atlas tumor pathology,tumors of the Kidney,Renal
- 14 Copyright Noriharu mikata 2016 All Rights Reserved
Pelvis ,and Ureter. Armed Forcess Institute of Pathology,Washington,D.C. 1975.
)
46:271-277,1995
72:3553581981.
32:837-842,1986.
38:1871790,1992.
,4:843850,1991.
,6:6775,1993.
,6:571579,1993.
,6:865872,1993.
13:6770,1994
27:672
6781981.
51:393 395,1990.
62:157-160,2000
62:153-156,2000
Mugiya S.,Ozono S.,Nagata M.,Otsuka A.,Takayama T.,Nagae H.:Retrograde endoscopic
leaser therapy and ureteroscopic surveillance for transitional cell carcinoma of upper urinary tract.
Int.J. of urol.,13:1-6,2006
Cyclophosphamide,Adriamycincis-Platin
,22:1 7,1990.
- 15 Copyright Noriharu mikata 2016 All Rights Reserved
35:1807 1811,1989.
- 16 Copyright Noriharu mikata 2016 All Rights Reserved
2
A.
1991 150
1996 20
[]
[] 168 2
20 80
60
131 36 3
81 80 9
157 71 45.2%
157
97 61.8%
61 38.9%
149 29 19.5%57 38.3%
41 25.7%1991 20 11
55%
1984 42 18 43%
11
57 68 6 131
24 11 1 36
0 1 2 3
81 80 9 170
1:
67(42) 42.7
37(7) 23.6
11(5) 7
21(6) 13.4
8(6) 5.1
2(2) 1.3
1(0) 0.6
10(3) 6.4
157(71)
2:
():
- 17 Copyright Noriharu mikata 2016 All Rights Reserved
SCC
20 167
96 57.5%
82.3% 14
1991 20
11 8
1
59.1% 6 70.5% 1
[]
[]
:
53:1056-1061,1991
170
42:451-455,1996
:60:787-790,1998
Mizusawa H.,Komiyama I.,Ueno Y.,Maejima Kato H.:Squamous cell carcunoma in the renal
pelvis of a horseshoe kidney.Int.J.Urol.,11,782-784,2004
Shimasaki N.,Inoue K.,Nishigawa H.,Kuroda N.,Shuin T.:Combined small cell carcinoma and
sarcomatoid squamous cell carcinoma in the renal pelvis.Int.J.Urol.,12,686-689,2005
B:
1995
61 1996 64 ,1998 67
2007 68
61
58 31 25 2 1.2:1
30 28 59.6%
61.3 60 57.9
56.1% 8.8%80%
7
16 10
BLMCDDP
58 5 9.6%
40-45% 6-8%
79
14
3
26
13
+ 8
7
1
16
3
3:
- 18 Copyright Noriharu mikata 2016 All Rights Reserved
basaloid squamous carcinoma
41,471-474,1995
42:899-901,1996
60:784-786,1998
4 58:243-245,2004
5 CDDP/5-FU
43:41-44,1997
6Maeda D.,Fujii A.,Yamaguti K., Tominaga T.,Fukuyama M.,Mori M.:Sarcomatoido carcinoma
with a predominant basaloid squamous carcinoma component:The first report of an unusual
biphasic tumor of the ureter. Jpn.,J.,Clin.,Oncol.,37:878-883,2007
- 19 Copyright Noriharu mikata 2016 All Rights Reserved
92%
7% 1%
1997
45
2004
96
2004
6
3
72
72
1930 52 1
1942 44 5 1
1952 44 5 1
1953 21 1
1960 60 1
1961 77 6 1
Suzuki 1965 52 2
1968 30 1
1969 55 1
1972 49 1
Suzuki 1972 87 2
1973 69 1
1973 59 20 1
1974 40 1
1975 65 6 1
1975 73 1
1981 59 70 1
1981 54 4 1
1982 75 3 1
1983 37 1 1
1983 64 2 1
1983 57 3 1
1984 64 1
1984 53 1
1984 58 1
1985 64 1
1986 75 4 1
1986 51 30 1
1986 31 1
1987 64 1
1987 56 1
1987 59 3 2
1988 72 1
1988 77 1
1988 55 23 1
1988 76 1
1988 73 9 3
1988 68 12 4
aA
- 20 Copyright Noriharu mikata 2016 All Rights Reserved
72
21
87
62.2
45
27
35
31
6
25
35
12
26
22
24
33 9
30
13
6
53 20
30 9
3
1 X CT 2
Nephrogenic metaplasia59:209-213,1997 66:665-670,2004 Takehara K.,Nomata K.,Eguchi J.,Hisamatu H.,Maruta S.,Hayasi T.,Koga S.,Kanetaka H.:Mutinous adenocarcinoma of the renal pelvis associated with transitional cell carcinoma in the renal pelvis and the bladder. Int.J.Urol.,11:1016-1018,2004 14:45,1996 ) 7:46-48,2004
1989 62 3 1
1989 48 10 1
1990 41 1
1990 51 20 1
1990 76 1
1991 67 3 2
Ishikura 1991 72 2
1992 60 18 5
1993 79 13 1
Shibahara 1993 56 8 2
1994 64 2 1
1996 55 3 1
1996 69 3 2
Tsuzuki 1996 84 2 2
1996 79 6
1997 69 BCG 4 2
1997 76 2
1997 62 21 3
1999 70 1 2
2001 80 6 7
2002 41 2
2003 85 3 3
2003 62 4 8
Takehara 2004 67 3
2004 78 9
2004 68 2 10
Onishi 2005 72 12 11
2005 76 14 12
2006 58 16 13
Zennami 2007 66 6 14
2007 79 42 15
2007 58 16 16
2008 64 24 17
2008 68 18
1b:B)
:
- 21 Copyright Noriharu mikata 2016 All Rights Reserved
46:751-718,2004 Ohnishi T.,Franco M.E.,Shibahara T., Arima K.,Sugimura Y.:Papillary adenocarcinoma of the renal pelvis and ureter Producing carcinoembryonic antigen,carbohydrate antigen 19-9 and carbohydrate antigen 125.Int.J.Urol.,12:214-216,2005 97:607-609,2006 Zennami K.,Yamada Y.,Nakamura K.,Katuda R.,Tobiume M.,Naruse K.,Aoki S.,Taki T.,Honda N.:Primary adenocarcinoma of the ureter:report of a case. Acta Urol.Jpn.,53:645-648,2007 :53:883-886,2007 53:247-250,2007 49 2008.6.21 1 49 2008.6.21
- 22 Copyright Noriharu mikata 2016 All Rights Reserved
20%
2006 13 2
15
9
24 1:
37 98 67.2
17
7
17 5
1
DIP,RP,X CT MRI
NSE
multipotential epithelial reserve cell
14
1
1
5
1990 62 pT3 8 3
1993 64 pT4 3
Tsutsumi 1993 60 pT3 16 3
1994 37 6
1995 78 7 7
1998 56 pT3 6 3
2000 61 pT4 18 3
2000 52 6 3
2000 75 8
2001 73 pT3 3
2001 86 pT3 6 3
2001 98 9
2002 88 10
2003 69 6 3
2004 69 11
2005 53 pT3 8 3
2005 79 pT3 5 3
2005 60 pT3 4 3
Shimasaki 2005 61 11 12
2006 69 pT2 3 3
2006 70 pT3 3 4
2007 58 T3 4 13
2007 65 T3 8 14
2008 69 pT3 14 5
1:
:
- 23 Copyright Noriharu mikata 2016 All Rights Reserved
T3
12T2 1T4 2 98
2
20 7 2
14 95
24 9
3 18 13 2
67
1
17:1269-1273,1999 17:1274-1278,1999 76:48-52,2006 43 2006.6.10 1 54:411-413,2008 33:958,1994 41:47-50,1995 13:1128,2000 90:275,2001 40:94-95,2002 43522,2004 Shimasaki N.,Inoue K.,Nishigawa H.,Kuroda N.,Shuin T.: Combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis.Int.,J.Urol.,12:686-689,2005 20:739,2007 53:739,2007 47:1223-1227,2005
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2004
Minami [] 7
1994 Nakajima [] 1 [] 1
9 9
19 67 51 7 2 3 6
1
1 4
5 2 3
[]
2005
16
2
18
12 74 54.8
10 8
non Hodgkin lymphma
Follicular lymmphoma
Hodgkin lymphma
13
10
3
12
2
*
1976 48 NHL 8
1979 12 HL 12 8
1983 35 NHL 6 8
1983 30 NHL 8
1986 54 FL 8
1993 69 FLB) 8
1996 39 FL 8
1997 41 FLB) 8
1998 57 FLB) 8 8
1998 52 HL 8
1999 58 FLT) 8
2000 74 NK cell lymphoma 2 8
2002 77 8
2002 71 FLB) 8
2002 72 MALT lymphoma 9 8
2004 58 NHL 15 9
2005 71 FLB) 8 8
Kubota 2007 68 NHL 10* NHL : n o n h o d g i k i n l y m p h o m a , NH : h o d g i n l y m p h o m a , F l : fo l l i c u r a l y m p h o m a , FL (Bo r T ) : fo l l i c u l a r l y m p h o m ama
FL(b or T):Follicular lymphoma(B or T cell type
2:
Nair 1977 59 1
Chen 1978 39 1
Kanamura 1983 19 1
Imamura 1988 65 1
Nakachi 1989 65 1
Tohda 1992 67 1
Nakajima 1994 33 2
Minami 2004 54 1
2005 58 3
1:
()
Yosida 1990 55 5
Fukuda 1991 68
Fukuda 1991 69
1991 70 5
Murata 1994 66 1
Murata 1994 80 3
Nagayosi 1997 60 5
Sekido 2000 73 9
2002 89 15
2002 65 8
3:
- 25 Copyright Noriharu mikata 2016 All Rights Reserved
2 12 1 15
26
5 89 62.8 15
11 15 4
14 4 2 1
1 6 6
3 16 1 2
3 2
1
Minami H.,Ueki O.,Tanaka T.,Nishida H.,Hashimoto T.,Kawaguti K.:Case of leiomyosarcoma of the renal pelvis. Int.J.Urol.,11:122-124,2004 Nakajima F.,Terahata S.,Hatano T.,Nisida K.:Primary Leiomyosarkoma of the Ureter Urol.Int.,53:166-168,1994 :67:263-265,2005 Townsend M.F.,Gal A.A.,Thoms W.W.,Newmann L.J.,Eble J.N., Graham,Jr.S.D.:Ureteral rhabdomyosarcoma Urology,54:561,1999 )Raj G.V.,Madden J.F.,Anderson E.E.:Liposarcoma preresenting as an intraluminal ureteral mass Urology,61:1035,2003 )Charny C.K.,Glick R.D.,Genega E.M.,Meyers P.A.,Reuter V.E.,La Quaglia :Ewing's sarcoma/primitive neuroectodermal tumor of the ureter:A case report and review of the literature J.Ped.Surgery 35:1356-1358,2000 )Koziol I.:Reticulm cell sarcoma Unusual cause of ureteral obstruction Urology,4:456-458,1974 51:269-272,2005 50:721-724,2004 Kubota Y.,Kawai A.,Tsuchiya T.,Kozimz K.,Yokoi S.,Deguchi T.:Bilateral primary malignant lymphoma of the ureter.Int.J.Clin.Oncol.,12:482-484,2007 48:29-32,2002 Sarcomtoido carcinoma 48:75-79,2002
- 26 Copyright Noriharu mikata 2016 All Rights Reserved
0.08%
0.01%
2004
18
46 75 60.6
11 7 11 7
10
13
7 4 3
1
1 45 14.6
10 2 2 1 1
1 1
3 16.6%
95:773-776,2004
53:739-740,2007
10 1 1 1 1 1 1 1 1
1:
- 27 Copyright Noriharu mikata 2016 All Rights Reserved
2000
32 3
trnsformation
transformation
28 3 1
24 82 2681% 50 23 9
26 2486%
46:117-121,2000
lymphoepithelioma-like carcinoma
Haga 3 75
Haga K.,Aoyagi T., Kashiwagi A.,Yamashiro K.,Nagamori S.:Lymphoepithelioma-like carcinoma of the renal pelvis. Int.J.Urol.,14:851-853,2007
- 28 Copyright Noriharu mikata 2016 All Rights Reserved
66 7
Vater
1981
2 1
73
10 507
.
35:51-57,1981 65:110-114,2002 4150 1998 2007
24 32.9 20 27.4 8 8.2 5 6.8 4 5.4 4 5.4 3 4.1 2 2.7 1 1.4 1 1.4 1 1.4 1 1.4 1 1.4 73 100
1:
47 9.3
6 1.2
114 22.5 3 0.6
19 3.7
8 1.6
21 4.1
26 5.1
84 16.6
60 11.8
6 1.2
6 1.2
7 1.4
13 2.6
18 3.6
37 7.3
39 39
33 6.5
10 2.0
507
2: