腎盂十二指腸瘻を伴った原発性腎盂腺癌の1例

Abstract

62歳女.主訴は右側腹部痛であった.CTにて右腎腫瘍を指摘され入院となった.精査によるCTで, 右腎結石, 右腎実質の菲薄化と右腎盂内に腫瘍性病変を認め手術となった.腰部斜切開したところ, 右腎と十二指腸の癒着が強く, 腎臓を摘出すると, 腎盂と十二指腸との瘻孔を認めた.又, 尿管も下大静脈壁と強く癒着していた為, 尿管摘除術は断念し, 瘻孔部の十二指腸を腹部正中切開にて部分切除し, 手術を終了した.病理では, 腫瘍は乳頭状腺癌で周囲への浸潤は認められなかった.瘻孔部及び十二指腸側への浸潤も認められず, 瘻孔の原因は急性及び慢性の腎盂腎炎による炎症と考えられた.術後7日目に創部感染を合併した為, 再縫合術を施行し, 7日後に退院となった.現在, 厳重に経過観察中である

A 62-year-old woman visited our hospital complaining of fever and right flank pain. On excretory pyelography the right kidney containing three renal stones was not visualized. Retrograde pyelography revealed an irregular filling defect in the right renal pelvis. Computed tomography revealed renal stones and a tumor mass in the right renal pelvis. From these findings, the pelvic tumor of the right kidney complicated by renal stones was diagnosed. Right nephrectomy was performed. Because a fistula between the renal pelvis and the second portion of the duodenum was found in the operation, partial resection of the duodenum was also performed. Pathological diagnosis was adenocarcinoma of the renal pelvis and pyeloduodenal fistula due to chronic pyelonephritis. Postoperative chemotherapy was not given. This is the first case report of adinocarcinoma of the renal pelvis coexisting with a pyeloduodenal fistula.