馬蹄鉄腎に発生したムチン産生性腎盂腺癌の1例

Abstract

41歳男.腹部膨満感が出現し, 血尿も認め, 腹部CT, DIPで馬蹄鉄腎および左腎腫瘤を認め入院した.逆行性腎盂造影で, 左腎盂拡張認め, 腎盂尿細胞診はsuspiciousであった.腹部CTで壁の石灰化を伴う, 嚢胞性腫瘤を認め, 大動脈分岐部にリンパ節腫大を認めた.腹部血管造影で腎動脈は5本あり, 峡部に入る腎動脈の支配領域に病変の存在が疑われた.馬蹄鉄腎峡部に入る腎動脈の選択的造影ではtumor stainを認めず, hypovascular tumorであった.腹部MRIT2強調画像で馬蹄鉄腎峡部の嚢胞性腫瘤と診断, 第一腰椎と左腸骨に骨転移を認めたため手術した.術中迅速病理診断はムチン性腺癌で, 左半腎および尿管全摘術, リンパ節切除および郭清術を施行した

A 41-year-old man with macroscopic hematuria and abdominal fullness was referred to our hospital. Computed tomography (CT) revealed a left renal pelvic tumor in the horseshoe kidney. We performed left heminephrectomy and ureterectomy. The pathological diagnosis was the mucinous adenocarcinoma in the renal pelvis. He received postoperative adjuvant chemotherapy (CAP therapy). He died of retroperitoneal recurrence 8 months postoperatively. In the literature we found 95 cases of primary adenocarcinoma in the renal pelvis including our case.