ベリニ管癌の1例

Abstract

53歳男.右腎盂腫瘍の疑いで精査目的入院した.RP・CT・MRIで, 右腎上極に径2cmの境界不明瞭な不整形な病変を認め, 病変は一部腎杯を圧排し, 腎盂との境界が不明瞭であった.尿細胞診がTCCであり, 術前診断はT3N0M0の腎盂腫瘍もしくはTlaN0M0の右腎細胞癌を考え, 根治的右腎摘除術を施行した.術中迅速診断はベリニ管癌であったが, 移行上皮癌も否定できないので, 右尿管摘除術を追加した.肉眼的所見は右腎上極に出血壊死を伴う白色の腫瘍を認め, 腎盂への突出が認められた.術後の病理組織学的検査および免疫染色の結果から, ベリニ管癌と確定診断した.術後補充療法としてM-VAC1コースを施行した.術後は再発転移を認めない

A 53-year-old man was admitted to our hospital for the extensive examination and treatment of suspicioun of right renal pelvic tumor. Retrograde pyelography (RP), computed tomography (CT) and magnetic resonance imaging (MRI) showed a space-occupying lesion, about 2 cm in diameter, spread from the renal parenchyma to the renal pelvis. Right nephroureterectomy was performed because transitional cell carcinoma was suspected from the histopothology of the frozen section. The gross examination revealed a white tumor in the upper pole, protruding into the renal pelvis with hemorrhagic necrosis. Histological examination showed Bellini duct carcinoma of the papillary type. He received adjuvant combination chemotherapy with M-VAC (Methotrexate, vinblastine, doxorubicin, cisplatin). He has been alive without evidence of recurrence since the surgery.