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a. .......................................................................................................................................... 4

b .................................................................................................................................. 4

c .............................................................................................................................. 4

1 .......................................................................................................................... 5

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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......................................................................................................................16

A. ....................................................................................................................16

B: ......................................................................................................................17

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..........................................................................................................................22

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.................................................................................................26

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lymphoepithelioma-like carcinoma .....................................................27

.....................................................................................28


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:


.

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


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


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


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%


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


)

)

)


)

goblet sign

C.AP

D.



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


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


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.


35:1807 1811,1989.


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:

():


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:


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


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


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)

:


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


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:

:


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


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:


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


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:


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


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:

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