膀胱腫瘍の上部尿路に及ぼす影響について 第1篇: 病理解剖学的考察

Abstract

Pathological observations were made on 28 cases of c ancer of the urinary bladder necropsied during the period of 11 years from 1953 to 1963 with a specific respects on pathological changes of the upper urinary tracts which might be caused by the cancer. These 28 cases were classified in accordance with histological finding of the tumor to 16 transitional cell cancer, 6 squamous cell cancer, 3 undifferentiated cell cancer, 1 adenocarcinoma and 2 mixed type. Metastasis was found in 18 cases (64.3 %). For the macroscopic findings of the kidney at necropsy, infection s were the most frequently recognized change, such as pyelonephritis in 19 and renal abscess in 9 cases. Hydronephrosis and concurrent nephrolithiasis were also found in 8 and 4 cases respectively. In all of 50 kidneys of which histological examinations were performed, fi n dings compatible with pyelonephritis were recognized. This fact means that the corpse of bladder cancer are invariably accompanied with inflammatory changes in the upper urinary tract, especially in the kidney. With the cons i d erations of metastatic patterns, pathological changes of the kidney and influences of the surgery the cause of death was defined as follows. Five cases (17.8 %) were supposed to died of merely due to metastatic recurrence of the cancer and another 4 cases (14.3 %) were classified as operation death. On the contorary, 12 cases (42.9 %) were certainly died of renal functional insufficiency and 5 cases (17.8 %) must have died of both recurrence of the cancer and renal insufficiency. These results proved that renal insufficiency has an important role for cause of death in case of bladder cancer. Although the grading of malignant charactor and the staging of i n filtrating process of the tumors have merely conventionally ref ered for choice of therapy and determination of prognosis as highly specific appraisal in cases of bladder cancer, the results of our study indicated that the extent of the pathological changes in the upper urinary tracts especially the status of renal function must bP also taken in consideration.