Giant hydronephrosis with increased carbohydrate antigen19-9both in serum and fluid

Abstract

68歳男性.患者は全身倦怠感と食欲低下および1年前から徐々に腹部冒満感を来たすようになり, 著者らの泌尿器科へ入院となった.腹部CTの所見では右腎の位置に一致して巨大な内部均一, low densityな腫瘤を認めた.直ちに経皮的腎瘻増設術を施行し6500ml以上の血性内溶液を得た.内容液の細胞診の結果はclass IIIであり, CA19-9値は内容液のみならず血清中においても著明に増加していた.その後, 右腎摘除術を施行した.摘除標本では右腎は著明なUPJ stenosisを呈していた.病理組織学的検査の結果では悪性所見は認めず線維化を主体としたものであった

We report a case of right giant hydronephrosis. A 68-year-old man was admitted to our hospital with chief complaints of general fatigue, loss of appetite and a one-year history of progressive fullness on whole abdomen. Abdominal computed tomography scan exhibited a huge, homogeneous, low density mass originating from the right kidney. We performed right percutaneous nephrostomy and drained over 6, 500 ml bloody fluid. Cytological examination of the drained fluid revealed atypical nuclear appearance defined as class III. Increased values of carbohydrate antigen 19-9 were observed both in the fluid as well as in the serum. We performed right nephrectomy. Macroscopic appearance of the resected kidney showed marked stenosis at the portion of ureteropelvic junction. Histological analysis of the stenotic portion demonstrated marked fibrosis without findings of malignancy.