腎結石の手術中に発見した腎癌の2例

Abstract

Two renal cell carcinomas were incidentally found during the operation on renal stone. Case. 1. A 40-year-old man was first seen with dull pain over the right flank. X-ray examinations revealed renal stone in the right kidney. On operation, a semiglobular hard mass was found on the upper pole from which a biopsy specimen was obtained. A frozen section study revealed renall cell carcinoma, and nephrectomy was performed. Because the diameter of the tumor was within 2 cm, showing no radiological finding suggesting renal cancer, preoperative diagnosis might have been impossible. Precise history taking, however, disclosed that intermittent low grade fever, general malaise and gastrointestinal disorders had been present for two to three years. Case. 2. A 58-year-old man came to the hospital with gross hematuria as his chief complaint when a diagnosis was made as essential renal hematuria. Two years later, gross hematuria recurred when renal stone on the left was found. He was admitted to the hospital for surgery. Laboratory examinations revealed no abnormalities except for microscopic hematuria. On operation, renal cell carcinoma was incidentally found. Retrospectively, urograms shows lateralization of the longitudinal axis of the kidney, to which no attention had been paid. Intermittent fever and painless hematuria, frequently seen m renal cell carcinoma, should have been paid more attention. Twenty-six cases of renal cell carcinoma associated with lithiasis were reported in Japan, one thirds of them being found incidentally. If carefully checked retrospectively, some findings suggestive of renal cell carcinoma could be noted in these cases. If the patients with renal lithiasis showed intermittent gross hematuria, particularly painless hematuria, low grade fever, general malaise, gastrointestinal disorder and the radiological findings such as deviation of the longitudinal axsis of the kidney and bulging of the renal outline, presence of renal cell carcinoma should be strongly considered.