Pseudoaneurysmを形成し著明な嚢胞性変化を伴った腎血管筋脂肪腫の1例

Abstract

59歳女.左腎腫瘍を疑われ入院となった.画像診断所見から嚢胞性腎細胞癌を強く疑い左経腰的腎摘除術を施行した.腫瘍は周囲組織への癒着を認めず比較的容易に摘除可能であった.病理組織学的所見は腎血管筋脂肪腫であった.経過は良好で再発などは認めず, 現在外来にて経過観察中である

A 59-year-old woman consulted our hospital for a left renal mass which she had been aware of for 4 years. The tumor was in the lower portion of the left kidney. It was a cystic tumor whose wall was enhanced on computed tomography and magnetic resonance imaging. The lesion 3.0 cm in diameter, which was enhanced equally to the aorta, was found in a part of the wall. It was thought to be a pseudoaneurysm by renal angiography. We suspected a cystic renal cell carcinoma because of the plural feeding arteries and tumor staining, and performed left total nephrectomy. Pathological diagnosis was angiomyolipoma with few fat components. To our knowledge only 3 previous cases of renal angiomyolipoma with marked cystic degeneration have been reported in Japan. In all 3 cases, it was difficult in preoperative diagnosis to distinguish angiomyolipoma with cystic degeneration from cystic renal cell carcinoma complicated cyst. Moreover, this is the first reported case of renal angiomyolipoma with marked cystic degeneration and pseudoaneurysm.