大腿骨頭置換術後10年で発症した膀胱股関節瘻の1例

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85歳女.10年前に右変形性股関節症で右大腿骨頭置換術を受けた.肉眼的血尿が出現し来院した.膀胱鏡検査で右側壁に径2cm,非乳頭状の広基性腫瘤を認めた.CT, DIPでは,セメントが右股関節から骨盤骨の欠損部を通過して,膀胱部まで進展している所見を認めた.精査の為,入院し,経尿道的に腫瘍病変部の生検を行った.病理組織学的にセメントの微粒子を含む炎症性肉芽腫と診断したAn 85-year-old female, who had had a total hip replacement for osteoarthritis in 1985, presented with gross hematuria in June 1995. Cystoscopy revealed a non-papillary sessile tumor in the right side wall of the urinary bladder with a crateriform opening on the top. Computed tomographic (CT) scan and excretory urography demonstrated a fistulous communication between the bladder and the acetabular bed filled with cement. The biopsy of the mass lesion suggested inflammatory granuloma with powdered cement. Since the lesion was composed of internal fistula, and was not accompanied with infection, the patient was treated conservatively. No external fistula had formed during the 5 months of observation.