腎外傷により発見された腎実質腫瘍の1例

Abstract

A case of traumatic kidney rupture with pre-existing renal cell carcinoma in a 38-year-old male is reported. Macrohematuria appeared 48 hours after left precordial trauma in a traffic accident. Initial diagnosis at the emergency clinic was 9th rib fracture of his left chest alone and no other injury was recorded. A large mass in left abdomen was palpable at urologic OPD, however, and X-ray examination revealed a non-visualizing left kidney in IVP. After the ECHO, CT and arteriography findings gave an impression of left kidney rupture. Left nephrectomy accompanied by partial colectomy of descending colon by transperitoneal approach was performed 25 days after initial trauma. This delay was mainly due to disagreement of patient for surgical treatment because there were no subjective symptom except microhematuria and subsiding fever after transfer to the urologic section. En bloc removed specimen showed ruptured kidney with adhesiveness laterally to descending colon and harder core portion was found in midst of renal mass. Coronal slice of the specimen exhibited a renal parenchymal tumor with necrotic spots. Pathologic findings were complete kidney rupture in upper pole and clear cell type renal cell tumor was found in mid and lower pole. Also lymph nodes which obtained from left renal pedicle and para aortic margin proved no metastasis of tumor cell. Post operative clinical course was favourable without any recurrence for 15 months after surgery. Clinical incidence of type I and type II kidney trauma with pre-existing neoplastic change is considerably high, but the kidney ruptured case bearing renal cell carcinoma as a core shape is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)