Search

The aim of this study was to compare the perioperative results of robot-assisted partial nephrectomy (RAPN) with those of laparoscopic partial nephrectomy (LPN) for cT1 renal tumors. From August 2015 to March 2018, 63 consecutive cases undergoing LPN and RAPN (30 cases of LPN and 33 cases of RAPN) for renal tumors ≤7cm in diameter (cTla: 42 cases and cT1b: 21 cases) were evaluated. The trifecta was defined on the basis of the following three criteria: ischemic time less than 25 minutes, no positive surgical margin, and no perioperative complications within four weeks postoperative. The background factors were compared between the two groups. There were no cases requiring changes in the operation methods. There was no significant difference in age, body mass index, gender, or tumor side between the two groups. While the mean tumor diameter and mean RENAL nephrometry score (RNS) were 32.6 mm and 7.3, respectively, there were no differences between the two groups. The warm ischemic time of RAPN was significantly shorter than that of LPN (12.7 min vs 19.9 min, P = 0.0007), and the estimated blood loss of RAPN was less than that of LPN (58.6 ml vs 160.3 ml, P = 0.0005). While there was no apparent tumor damage, tumor exposure on the resection surface was observed in two cases. Perioperative complications were observed in four cases. The trifecta achievement rate of RAPN and that of LPN was 93.9% (31 cases) and 66.7% (20 cases), respectively. The initial perioperative results of RAPN were comparable with those of LPN for cT1 renal tumors.

A 59-year-old woman was referred to our hospital with the finding of an incidentaloma in her right kidney. Computed tomographyand magnetic resonance imaging showed a solid tumor, approximately8 cm in diameter, at the lower pole of the right kidney. Partial nephrectomy was performed without a renal vessel clamp. Histopathologically, fibroblast-like spindle cells were proliferating with rich collagenous fibers, and tumor cells were infiltrated into the renal parenchyma. The tumor cells were stained positive with CD34, CD99, and bcl-2. The tumor was diagnosed as solitaryfibrous tumor originating from the kidney based on these histopathological findings. The patient was followed 3 years after surgery with neither recurrence nor metastasis.

A 31-year-old man was referred to our hospital for macroscopic hematuria. An abdominal computed tomography (CT) scan showed a 36×30 mm enhancing left renal tumor with tumor thrombus extending into the left renal vein. Therefore, we diagnosed the tumor as a clinically classified cT3aN0M0 left renal cell carcinoma. Retroperitoneal laparoscopic radical left nephrectomy with renal vein thrombectomy was performed, with removal of the left kidney with the mass and tumor thrombus en bloc. The pathological diagnosis was epithelioid angiomyolipoma (EAML) of the left kidney. EAML is a rare tumor with malignant potential. In this case, although no signs of recurrence or metastasis have been observed for 9 months post-operation, we recommended a careful follow-up regimen.

We performed computed tomographic (CT)-guided percutaneous needle biopsy for renal tumors that were difficult to diagnose or were inoperable malignant renal tumors. Nineteen patients who underwent CT-guided percutaneous needle biopsy between November 2007 and March 2015 at Hamamatsu University Hospital were included in this study. The median tumor diameter was 78 mm (40-140 mm). Seventeen patients were diagnosed pathologically by biopsy, but 2 patients could not be diagnosed despite the existence of adequate sample volume. One patient had an adverse complication ; fever (CTCAE ver 4.0 grade 1). The median duration of follow-up was 21 months (0-111 months), no one had tumor seeding along a needle tract. CT-guided percutaneous needle biopsy of renal tumors is helpful for pathological diagnosis and further treatment planning. However, there are still some limitations to obtain an accurate diagnosis.

A 66-year-old woman was referred to our hospital for a right renal mass found in the examination for sudden right flank pain. Abdominal computed tomography (CT) revealed a right renal tumor, 8.0cm in diameter, with massive hemorrhage due to spontaneous tumor rupture. After transcatheter arterial embolization, right radical nephrectomy was successfully performed. The histopathological diagnosis of the renal tumor was epithelioid angiomyolipoma (eAML). Postoperative chest CT showed two lung tumors. Therefore, the lung tumors were resected and diagnosed as a primary lung adenocarcinoma and a sclerosing angioma. Although renal eAML is thought to have malignant potential, there has been no local reccurence nor distant metastases of renal eAML 11 months after the surgery.

A 58-year-old man from Brazil was followed as an outpatient with asymptomatic macroglobulinemia and idiopathic thrombocytopenic purpura (ITP). Abdominal enhanced computed tomographic (CT) scan for elevated liver enzymes revealed a left renal tumor. The tumor was in the middle outer left kidney, measured 18 mm in diameter, was discovered in its early phase, and appeared half exophytic. After investigations, the patient was diagnosed with left renal cell carcinoma associated with ITP. His preoperative platelet count was 10, 000/μl ; five days of intravenous gamma globulin therapy with high-dose dexamethasone increased the platelet count to 76, 000/μl just before operation. Laparoscopic left partial nephrectomy was performed successfully using the retroperitoneal approach. The renal artery was clamped and the tumor excised with an adequate margin. Renal parenchymal repair was completed using running sutures. Ischemia time was 16 minutes. There was no severe oozing of blood intraoperatively. The platelet count decreased to 15, 000/μl on postoperative day three (POD 3), and there was oozing of blood around the retroperitoneal drain tube. The bleeding stopped after administration of platelet transfusion. The patient was discharged on POD 9. The histopathological diagnosis was clear cell carcinoma, and surgical margins were negative.

We performed ultrasound-guided biopsies on 14 patients having tumors that were difficult to distinguish as benign or malignant on computed tomography. The study took place from January 2004 to December 2011. Of the 14 tumors biopsied, 12 were malignant, 1 was benign, and 1 was a sampling error. Of the 12 malignant tumors, 7 were primary kidney carcinomas. Six patients received radical or partial nephrectomies, and all had a good prognosis. Three patients with metastatic kidney cancers died of the primary disease. Eleven patients (85.5%) were diagnosed pathologically by biopsies, allowing us to decide the course of treatment. However, because our tests also revealed one sampling error and one unspecified cancer, we determined that there are limitations to a renal biopsy.

Case 1 : The patient was a 68-year-old man. Abdominal computed tomography performed during hospitalization for the close observation of a pituitary gland tumor, showed a right renal mass. Percutaneus needle biopsy revealed IgG4-related disease of the kidney. Pituitary gland tumor biopsy also indicated that the lesion was associated with IgG4-related disease. The pancreas did not show abnormalities. The patient was treated with prednisolone, and both renal and pituitary lesions markedly decreased in size. Case 2 : the patient was an 80-year-old man. Right hydronephrosis was observed, and computed tomography showed a right pelvic tumor. Right renal pelvic tumor was diagnosed, and the patient underwent right nephroureterectomy. Pathological examination showed that this tumor was also associated with IgG4-related sclerotic disease. IgG4-related disease tends to occur in multiple organs. This condition should be considered when treating patients with multiple sclerotic diseases. However, in some patients, the disease may be localized to a single site. Further studies are required to elucidate the characteristics of IgG4-related disease.

A 60-year-old man visited our hospital with a complaint of right renal incidentaloma which was pointed out on abdominal ultrasonography for a medical check-up. Abdominal computed tomography showed a renal tumor in the right kidney, which was a slightly high-dense relative to the renal parenchyma and was enhanced in the arterial phase. The tumor had grown gradually from 1.4 to 1.7 cm in diameter. After the observation for 4 years, he underwent pure laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator. Histological examination of the specimen revealed a leiomyoma of the kidney. This is the 5th case of successful laparoscopic partial nephrectomy for renal leiomyoma in Japan within the retrieved references.

A right renal tumor was incidentally found in a 38-year-old woman by annual medical check up. She visited our hospital for further examination and treatment. She did not show typical symptoms of carcinoid. A computed tomography (CT) revealed a calcified solid tumor in the upper portion of the right kidney. The tumor was 6.0 cm in diameter and was not enhanced in either early or late phase. There was no evidence of extrarenal invasion or distant metastasis. Based on a clinical diagnosis of stage 1 renal cell carcinoma, laparoscopic nephrectomy was performed. The pathological diagnosis was renal carcinoid tumor. The tumor had trabecular and ribbon-like structures with a thin fibrovascular stroma. Immunohistochemicaliy, the tumor cells stained positive for chromogranin A, synaptophisin and CD56. The cell proliferation rate was estimated to be under 1% with Ki67 staining. To find the primary lesion, we performed upper and lower gastric endoscopy and chest computed tomography, but could not find any/other carcinoid tumors. At 1-year follow up, she had no evidence of local recurrence or metastasis.

The patient was a 22-year-old woman with a history of tuberous sclerosis who complained of abdominal distention. Computed tomography showed bilateral renal masses with minimal fat tissue that were unlike classical angiomyolipoma (AML), as well as enlargement of the paraaortic lymph nodes, pleural effusion, and ascites, similar to other advanced malignant neoplasms such as renal cell carcinoma and renal sarcoma. We performed a left nephrectomy to relieve the symptoms. A pathological examination revealed that the tumor was composed of polygonal epithelioid cells positive for both αSMA and HMB-45, as well as spindle-shaped cells, while immunoreactivity proved the tumor to be an eAML, a subtype of AML with malignant potential. Although the patient was scheduled for postoperative adjuvant chemotherapy, her condition worsened and she died on postoperative day 24 before receiving chemotherapy. We discuss this case with reference to previous reports.

53歳男.右腎盂腫瘍の疑いで精査目的入院した.RP・CT・MRIで, 右腎上極に径2cmの境界不明瞭な不整形な病変を認め, 病変は一部腎杯を圧排し, 腎盂との境界が不明瞭であった.尿細胞診がTCCであり, 術前診断はT3N0M0の腎盂腫瘍もしくはTlaN0M0の右腎細胞癌を考え, 根治的右腎摘除術を施行した.術中迅速診断はベリニ管癌であったが, 移行上皮癌も否定できないので, 右尿管摘除術を追加した.肉眼的所見は右腎上極に出血壊死を伴う白色の腫瘍を認め, 腎盂への突出が認められた.術後の病理組織学的検査および免疫染色の結果から, ベリニ管癌と確定診断した.術後補充療法としてM-VAC1コースを施行した.術後は再発転移を認めない, A 53-year-old man was admitted to our hospital for the extensive examination and treatment of suspicioun of right renal pelvic tumor. Retrograde pyelography (RP), computed tomography (CT) and magnetic resonance imaging (MRI) showed a space-occupying lesion, about 2 cm in diameter, spread from the renal parenchyma to the renal pelvis. Right nephroureterectomy was performed because transitional cell carcinoma was suspected from the histopothology of the frozen section. The gross examination revealed a white tumor in the upper pole, protruding into the renal pelvis with hemorrhagic necrosis. Histological examination showed Bellini duct carcinoma of the papillary type. He received adjuvant combination chemotherapy with M-VAC (Methotrexate, vinblastine, doxorubicin, cisplatin). He has been alive without evidence of recurrence since the surgery.

50歳男.主訴は左腰背部痛.CT・MRI検査で左後腹膜腔に辺縁石灰化を伴う嚢胞性の巨大腫瘤を認め, また右腎は腎盂尿管移行部狭窄による水腎症を認めた.左後腹膜腫瘍の診断で, 後腹膜腫瘍摘除術および下行結腸合併切除術を施行した.病理組織学的診断は水腎症が長期存在していた左腎実質から発生した腎悪性末梢神経鞘腫瘍(MPNST)であった.術後3ヵ月, 左下肺野多発性転移のため死亡した, We report a case of malignant peripheral nerve sheath tumor (MPNST) of the kidney. A 50-year-old man was referred to our hospital because of left back pain. Computed tomographic scan and magnetic resonance imaging revealed a huge left retroperitoneal tumor (30 x 13 x 11 cm), which consisted of a solid tumor with calcification surrounding the cystic component. He underwent resection of the retroperitoneal tumor and additional descending colectomy. Histopathological examination revealed MPNST arising from severely atrophic renal parenchyma of giant hydronephrosis. He died of tumor metastasis to the lungs 3 months after the operation. To our knowledge, this is the fourth case of MPNST of the kidney, moreover the third case arising from the renal parenchyma to be reported in Japan.

マイクロ波組織凝固装置(OT-110M)を用いた腎腫瘍核出術を施行した5症例7腫瘍を対象に臨床的検討を行った.7腫瘍は全て偶発癌であり, CRP, 血沈等acute phase reactantも前例正常であったが, 1例のみ免疫抑制蛋白が高値を示していた.又, 腫瘍径は対側腎機能正常例では全例4cm以下であった.平均手術時間は241分, 平均出血量は788mlで1例のみ輸血を行った.術後合併症は, 尿漏1例, 術後イレウス1例を認めた.病理組織所見は全例腎細胞癌であった.予後は最長1年6ヵ月の経過観察中で全例に再発は認めず, 現在も経過観察中である.又, 術後腎機能も全例術前とほぼ変化なく良好である, We report our clinical findings on 7 tumors in 5 patients who underwent successful enucleation of renal tumor with a microwave tissue coagulator. All patients presented with incidentally-found renal tumor on ultrasonography or computed tomography. One patient had bilateral renal tumors. The mean size of the renal tumor was 2.5 cm (Range 1.0-5.2 cm). One patient had a tumor larger than 5 cm, and was found to have renal insufficiency preoperatively. Four cases were clinically diagnosed as T1aN0M0. In all patients, the renal tumor was enucleated with a microwave tissue coagulator successfully without renal pedicle clamping. The mean operative time and blood loss were 241 minutes and 788 ml, respectively. The pathological diagnosis was renal cell carcinoma in all cases. Although 2 patients had preoperative renal insufficiency, there were no serious postoperative complications and no evidence of loss of renal function as a result of this operation. Our findings suggest that renal tumors can be enucleated with a microwave tissue coagulator safely and successfully without damaging renal function.

69歳男.横行結腸癌を同時性に重複した中等度腫瘍径の嚢胞状腎細胞癌を経験した.マイクロ波組織凝固装置を用いた腎保存手術を行い, 腫瘍核出に伴う腎盂欠損を術中修復しえた.腎保存手術の適応がさらに拡大しうることが示唆された, A 69-year-old man was referred to our department for a cystic tumor, 4.0 cm in diameter, in the lower portion of the right kidney, which was detected by computed tomography. The patient had been admitted to the department of surgery in our hospital for treatment of ileus caused by transverse colon cancer. With a diagnosis of cystic renal cell carcinoma. T2N0M0, in situ non-ischemic tumor enucleation was performed using a microwave tissue coagulator (Microtaze, Heiwa Electronics Industry Inc., Tokyo). The enucleation was accompanied by a defect of the renal pelvis, but it was easily repaired. The operation time was 120 minutes and blood loss was 110 cc. The histological diagnosis was renal cell carcinoma, pT2N0M0V1, expansive, alveolar type, clear cell subtype, G1 > G2. Diagnostic imaging done postoperatively showed no sign of damage to renal function. At the present time, the patient has been disease-free with interferon-alpha for 12 months and is being followed on an outpatient basis. In this report, the advantages of nephron-sparing surgery, especially in situ non-ischemic tumor enucleation using a microwave tissue coagulator for renal tumor are discussed. In particular, the technique of performing tumor enucleation with repair of the defect of renal pelvis used in this case may extend the indication of nephron-sparing surgery.

A 44-year-old woman was admitted with acute hepatic dysfunction. Screening computed tomography showed an enhancing mass of about 9 cm in the right renal upper pole. An open right nephrectomy was performed for the pre-operative diagnosis of renal cell carcinoma. Pathological examination revealed a perivascular epithelioid cell tumor (PEComa). PEComa is a rare tumor, which includes angiomyolipoma and lymphangiomyomatosis. It is sometimes associated with aggressive clinical behavior such as local recurrence and metastasis. She had no evidence of recurrence at 34 months follow up.

症例は45歳女性で肉眼的血尿を主訴とした.左背部痛も出現し増強したため救急外来を受診した.腹部超音波で左腎に径12cmの巨大腫瘍性病変を認め入院した.腹部CTで左腎の巨大腫瘍による強血尿及び貧血と判断し, 安静及び輸血による保存的治療を施行した.腹部CT, MRI, 血管造影等の所見より悪性腫瘍と診断し, 第8肋骨切除で経腹的根治的左腎摘出術を施行した.病理組織所見から色素嫌性腎癌と診断した.色素嫌性腎癌は1974年にラットにおける実験的な腎腫瘍発生モデルで通常の腎細胞癌とは異なる組織像を呈する腫瘍として報告された.わが国における臨床報告例は現在まで9例の報告例があるにすぎない, We report a case of chromophobe cell renal carcinoma. A 45-year-old woman with a chief complaint of macrohematuria and left backache was introduced to our hospital in October 1998. Abdominal computed tomographic scan (CT) revealed a solitary, solid mass (16 x 14 x 12 cm) at the upper pole of the left kidney. Angiography showed a hypervascular character but irregular neovasculizations were found. We performed a radical nephrectomy with a preoperative diagnosis of malignant renal tumor. The cut surface appearance of the tumor was homogeneous, grey-beige and solid. Light microscopic findings revealed voluminous cells with light, but not clear cytoplasm displaying a fine reticular pattern. Histochemical staining with Hale's colloidal iron stain demonstrated a distinctly positive cytoplasmic reaction. Since the ultrastructural study revealed numerous intracytoplasmic microvesicles, we finally reached the diagnosis of chromophobe cell renal carcinoma. We report our case here with reference to the relevant literature.

症例は22歳女で, 肉眼的血尿と右背部痛を主訴とした.画像所見から右腎の悪性腫瘍を強く疑い, 経腹式根治的右腎摘出術を施行した.腫瘍は腎下極にあり, 径5×5×5cmの黄白色・充実性で, 明らかな腎被膜外への進展はみられなかった.顕微鏡学的には, 好塩基性の胞体を有する核細胞質比の大きい上皮性腫瘍細胞の管状及び管状乳頭状の増生がみられ, 一部に芽腫成分を認めた.間葉系成分は少ないものの, ごく一部に分化した軟骨組織を認めた.これらの所見から成人型Wilms' tumorの上皮型と診断した.術後補助療法は患者の強い希望で施行せず経過観察となったが, 術後26ヵ月経過して再発は認めない.本例を加えた成人型Wilms' tumorの報告例16例について臨床的検討を行ったところ, 疼痛や腹部腫瘤, 血尿など何らかの臨床症状を呈した症例が多かった.また, 初診時に隣接臓器への浸潤もしくは血行性遠隔転移を認めた症例が半数近くを占めていた, We present a case report of adult Wilms' tumor and reviewed from 1981. A 22-year-old woman with chief complaints of gross hematuria and right backache was introduced to our hospital in March 1998. Abdominal computed tomography (CT) revealed a solitary irregular mass (5.0 cm) at the lower pole of right kidney with no contrast medium enhancement. Angiography showed a hypovascular character, but irregular vascularization was found in the tumor. We performed a radical nephrectomy with a preoperative diagnosis of malignant renal tumor. Finally, adult Wilms' tumor (epithelial type) was diagnosed by pathological examination. We retrospectively studied the clinical and radiological features in 16 reported cases of adult Wilms' tumor from 1981. The average age was distinctly younger than that of renal cell carcinoma. Nearly half of the cases were at an advanced clinical stage (direct invasion or metastasis to other organs) at first consultation. Radiologically, Wilms' tumor tends to be visualized as a low density mass in the precontrast CT scan (75.0%) and hypovascular tumor by selective angiography (84.6%). Although this is not a definitive character to distinguish adult Wilms' tumor from renal cell carcinoma, it may be useful information for differential diagnosis.

Chromophobe cell renal carcinoma is an uncommon subtype of renal cell carcinoma and the number of cases studied is still limited in Japan. We here report a case of chromophobe cell renal carcinoma in a 41-year-old Mexican male. He visited our branch hospital with the symptom of upper abdominal pain. Ultrasound examination showed a left renal mass. He was admitted to our hospital for treatment of a left renal mass. Radiological examinations revealed a hypervascular tumor in the left kidney. Under the clinical diagnosis of possible renal cell carcinoma, left radical nephrectomy was performed. This tumor was diagnosed as chromophobe cell renal carcinoma with a microscopic examination of H & E stained specimens, histochemical staining using Hale's colloidal iron and an ultrastructural study.

Solitary fibrous tumor (SFT) of the kidney is rare. A 76-year-old woman was referred to our hospital with a complaint of an incidentaloma of the right kidney. Computed tomography revealed an ovoid, hypervascular tumor in the right kidney. Magnetic resonance imaging showed a low intensity tumor occupying the upper calyx of the right kidney (T2 weighted image). Laparoscopic right radical nephrectomy was performed. An immunohistochemical study using a monoclonal antibody directed against the human hematopoietic progenitor cell antigen (CD34) stain confirmed SFT. The follow up at 48 months after surgery showed no recurrence or distant metastasis.

他疾患の精査中, 偶然発見された腎腺腫の1例を報告した。症例は78歳男性で, 4年前の膀胱癌に対するBCG膀胱内注入療法後の定期的な膀胱鏡検査でビロード状粘膜を指摘された。腹部造影CTに膀胱癌の転移を示唆する所見はなかったが, 右腎下極に動脈相で濃染する径10mmの腫瘍性病変を認めた。右腎細胞癌(cT1aN0M0)と診断し, 右腎部分切除を行った。切除した腫瘍は重量5g, 最大径10mmで, 病理組織学的には1層性の好酸性上皮が管状乳頭状に発育し, 被膜の形成や腫瘍内部の出血, 壊死は認められず, 核は小型, 均一で異型性に乏しかった。腫瘍は腎腺腫で, 定期検査で指摘されたビロード状粘膜変化は慢性膀胱炎の所見であった。腎腺腫は術前の画像検査で確定診断が困難なことが多い。良性腫瘍の可能性もある小さな腎腫瘍に対しては, 腎部分切除術が診断・治療に有効であると考えられた。, We report a case of renal adenoma which was diagnosed as renal cell carcinoma preoperatively. A 78-year-old man, who had been under observation for bladder cancer for 4 years, was incidentally found to have a small right renal tumor at follow-up computed tomography (CT). Enhanced CT demonstrated a tumor which was hypervascular, 10 x 10 mm size, at the lower pole of the right kidney. There was no evidence of distant metastasis. The preoperative diagnosis was renal cell carcinoma, cT1aN0M0, and we performed right partial nephrectomy. The histopathorogical finding was renal adenoma. Renal adenomas are benign tumors and not uncommon in autopsy cases. However, when they are detected clinically, it is difficult to distinguish them from renal cell carcinoma preoperatively.

55歳女。成人病検診を受診した際、腹部超音波検査にて右腎嚢胞を指摘された。腹部超音波断層法では右腎に内部エコー不均一で複数の嚢胞を伴う腫瘤を認め、排泄性腎盂造影では右腎盂に腎盂外からの圧排による陰影欠損を認めた。造影CTでは右腎外側にhypervascular tumorとは異なる漸増性の造影効果を示す腫瘤を認め、腫瘤内には造影効果の嚢胞様陰影が多発していた。以上より、乏血管性腎細胞癌、嚢胞性腎細胞癌などを考え経腹的根治的右腎摘除術を施行した。摘出標本の病理組織学的所見は、腫瘍は紡錘型・多型核と好酸性の細胞質を持つfibroblast様の束状繊維組織と脂肪成分が主体であり、嚢胞、血管成分も認められた。免疫染色ではwide keratinに染まる上皮細胞を嚢胞壁に認め、αSM抗体で染まる平滑筋組織を認めたが、HMB45は陰性であった。以上より、Mesoblastic nephromaと診断した。, We report a rare adult case of mesoblastic nephroma. A right renal mass was detected in a 51-year-old woman by ultrasonography. The radiographic examination revealed that the mass was the hypovasucular tumor, but there was a possibility of a malignant tumor. We therefore operated on her for right radical nephrectomy. The tumor was 40 X 52 mm in size and had several cysts. Based on the histological analysis, we diagnosed it as congenital mesoblastic nephroma consisting of spindle cells.

無症候性肉眼的血尿を訴えた59歳女で, 腹部CTは左腎に約4cmの少し増強される腫瘤, 血管造影は左腎に血管過小腫瘤, をそれぞれ描出した.腎細胞癌の診断で根治的左腎摘除術を行った.肉眼的に腫瘍の割面はベージュ色で, 少数の出血・壊死巣を持っていた.組織学的に腫瘍は通常のヘマトキシリン-エオジンで軽く染色される容量の大きい網状細胞質を持つ細胞より成っていた.Haleのコロイド鉄染色は陽性細胞質反応を示した.病理診断は嫌色素性細胞腎癌であった, We report a case of chromophobe cell renal carcinoma. A 59-year-old female was admitted to our hospital with asymptomatic gross hematuria. Abdominal computerized tomography showed an approximately 4 cm. minimally enhancing mass in the left kidney. Angiography revealed a hypovascular tumor in the left kidney. Under the diagnosis of renal cell carcinoma, left radical nephrectomy was performed. The cut surface of the tumor was beige in color with few foci of hemorrhage and necrosis. Microscopically, the tumor was composed of the cells with voluminous reticulated cytoplasm stained lightly with routine hematoxylin and eosin. Hale's colloidal iron staining demonstrated a positive cytoplasmic reaction. Pathological diagnosis was chromophobe cell renal carcinoma. Chromophobe cell renal carcinoma is a recently established subtype of renal cell carcinoma, which has rarely been reported in Japan.

39歳男.Bellini管癌, 乳頭腺癌型(pT3bN2M0)の症例を報告した.被膜形成を認めず, 浸潤性の発育を示し, 非常に特徴的な肉眼・画像所見を示した.この所見は過去に報告されている腎発生の移行上皮癌と類似していた.左根治的腎摘除術術後の補助療法として尿路上皮癌に準じたMVAC療法を施行した, We report a case of Bellini duct carcinoma of the left kidney with invasive growth pattern. A 39-year-old man was admitted to our hospital with the chief complaint of gross hematuria. Ultrasonography showed left renal swelling but normal reniform configuration of the kidney was maintained. Computed tomography demonstrated a low density tumor infiltrating into the renal cortex and with tumor extension into the renal vein. Renal angiography revealed a hypovascular tumor. We suspected a left renal cell carcinoma with tumor extension into the left renal vein, and performed radical nephrectomy. Macroscopically, the resected kidney had a normal outer contour. The tumor with infiltrative growth pattern existed in renal medulla. Histopathologic examination revealed a papillary adenocarcinoma originated in Bellini duct (pT3bN2M0). The patient underwent systemic chemotherapy (M-VAC). This case showed invasive growth pattern, which were different from the usual renal cell carcinoma and Bellini duct carcinoma.

59歳女.TAE後3週目に発症した気腹を伴う後腹膜膿瘍の1例を報告した, Transcatheter arterial embolization (TAE) has been commonly used in the treatment of renal cancer. Postembolization syndrome consisting of fever, flank pain and gastrointestinal symptoms is encountered in almost every case. We report a case of E. coli-induced retroperitoneal abscess accompanied by intraabdominal free air which developed three weeks after TAE in a 59-year-old woman with T4N0M0 renal cancer. No fistula between abscess and gastrointestinal tract could be demonstrated by gastrofiberscopy and barium enema. Urine culture just before TAE should be examined to avoid such a complication.

症例は44歳の女性で, 健康診断の超音波検査で右腎腫瘤を指摘され精査目的で入院した.腎超音波検査では右腎中部に径3cmの高エコーの充実性腫瘤を認め, カラードップラーエコーで腫瘤内に血流は認めなかった.針生検により高分化な腎細胞癌が疑われ右腎摘出術を行った.組織学的検索において, 特徴的な細胞形態及び配列, Grimelius染色強陽性であること, 更に電子顕微鏡にて神経分泌顆粒を認めたことにより腎カルチノイド腫瘍と診断した, The patient was a 44-year-old woman in whom a mass of the right kidney was found when she underwent abdominal ultrasonography in a physical checkup. The computed tomography of abdomen and the magnetic resonance imaging of abdomen revealed a 3 x 3 cm solid mass at the right kidney. Excretory urograms showed a deformity of the right collecting system due to a mass lesion. The specimen of the resected tumor showed a cellular arrangement specific to carcinoid tumor and positive reaction of Grimelius stain. Electron microscopy confirmed the presence of dense-core granules in the tumor cells. Gastrointestinal investigation after the operation revealed no particular findings suggesting a carcinoid syndrome. No evidence of metastasis or recurrence was noted for 5 months after the operation. This was a very rare case of primary renal carcinoid tumor, representing the 12th case in the literature in Japan.

A 63-year-old woman was admitted to our hospital for a left renal tumor with multiple cystic lesions. Computed tomography and renal angiography revealed a hypovascular tumor 9 cm in diameter and multilocular cyst with a thick wall. Renal cell carcinoma and multilocular cystic nephroma were suspected, and left nephrectomy was performed. Histopathological diagnosis of this tumor was renal oncocytoma.

We report a case of multilocular cystic renal cell carcinoma seen in a 54-year-old man. At the annual health check he was found to have numerous cysts of various sizes in the lower pole of the left kidney. Plain CT scan disclosed a mass in the lower pole of the left kidney. On enhanced CT scan septa were visible, suggesting a multilocular cyst. Left renal arteriography disclosed a hypervascular mass in the lower pole of the left kidney. Radical nephrectomy was performed. The gross appearance of the cut surface showed a feature of multilocular cyst. The histopathological diagnosis was clear cell carcinoma. We describe the clinical features of multilocular cystic renal cell carcinoma and discuss the differential diagnosis.

透析中の患者167例をACDKの有無に従い2群に分類し, 各種検査成績を比較した.胃癌が疑われた12例とACDKの自然破裂により後腹膜腔に大出血をきたした1例の計13例に腎摘を施行し, 病理学的検討を行った.ACDKを認めた症例は63例, 平均透析期間は10.3年であり, ACDKを認めない群の平均透析期間5.0年との間に有意差が認められた.特に, 10年以上の症例では64.6%にACDKがみられた.ACDK群ではHt値, Hb値が有意に高かった.腎癌が疑われた12例中8例に組織学上腎細胞癌が, 1例に腺腫が認められた.後腹膜腔への出血をきたした症例に嚢胞上皮の過形成がみられた.8例の腎癌症例中5例にACDKが, 2例に組織学上嚢胞が認められ, うち1例はCAPD症例であり, また1例は両側腎癌症例であった.摘出腎に腎細胞癌以外の変化, すなわち嚢胞上皮に過形成あるいは腺腫が認められた症例は8例中5例であり, いずれも透析歴7.5年以上の症例であった.腎癌症例の発見時平均年齢は44.7歳で, 無症状患者の定期的スクリーニングによって発見された, Long-term dialysis patients frequently develop acquired cystic disease of the kidneys (ACDK). One hundred and sixty-seven dialysis patients were classified into two groups according to the presence or absence of ACDK, and the two groups were compared with regard to the dialysis period, laboratory findings, and so forth. Among the 167 dialysis patients, 37.7% showed ACDK and had an average dialysis duration of 10.3 years, which was significantly longer than the 5.0 years for patients without ACDK. The proportion of patients with ACDK rose with increasing duration of dialysis; 64.6% of the patients on dialysis for more than 10 years had ACDK. The values of hemoglobin and hematocrit of patients with ACDK were significantly higher than those without ACDK. Of 12 dialysis patients who were operated upon because of suspected renal tumor, pathological examination confirmed renal cell carcinoma in 8 and adenoma in one. One of these patients had been treated with chronic ambulatory peritoneal dialysis, and another had bilateral renal tumor. Among the 8 patients with renal cell carcinoma, ACDK was detected in 5 by means of CT and ultrasound tomography, and cystic changes were observed in two on light microscopic examination of the resected kidneys. Pathological examination of the non-tumorous renal tissues revealed hyperplastic or adenomatous changes in the cyst epithelium in 5 patients undergoing dialysis for more than 7.5 years. These changes were thought to be pre-neoplastic. The high incidence of ACDK and the development of renal tumors in long-term dialysis patients indicates the necessity of intensive monitoring.

A case of renal cyst associated with renal tumor is presented herein. A 40-year-old male patient visited our outpatient clinic for left renal cyst which had been found by ultrasonography on routine clinical examination. CT scan demonstrated an irregular area in the cyst wall measuring about 2 cm in thickness which showed enhancement of density with contrast medium. Magnetic resonance imaging (MRI) also demonstrated a round mass with abnormal signal on the cyst wall, protruding into the cyst cavity. Transabdominal radical nephrectomy was performed on 13 July 1987, and to the resected kidney was attached a cyst measuring 7 cm in diameter in the lower pole. Grossly, the cyst contained amorphous red-brown material which turned out to be old blood clots and the wall harbored a tumor (3.0 x 2.5 cm). Histologically, the tumor was renal cell carcinoma, the surface of which was covered with necrotic tissue. The coexistence of renal cyst and tumor is rare and 62 cases were collected from the Japanese literature including our case, and discussion was made in relation to the etiological factors.

A case of multiple renal leiomyoma of the right kidney in a 60-year-old woman, complaining of lower abdominal pain of two months duration, is presented. Ultrasonography, intravenous pyelography and CT scan showed the masses at the right renal sinus and hilus. Selective right renal angiography demonstrated very hypovascular tumors. Right radical nephrectomy was performed. There were two lobulated tumors with no connections, which were elastic hard in consistency and smooth in surface; one was 4 x 2 x 2 cm in size and located at the renal sinus between the upper and middle calyces, the other was 6.5 x 5 x 4 cm in size and located at the renal hilus, apart from the renal parenchyma, pelvis, artery and vein. Histological examination revealed these tumors to be benign leiomyoma. Both were covered with the Gerota's fascia, but not the renal capsule. The renal parenchyma was completely covered with the renal capsule histologically, although these tumors were closely attached to the parenchyma on gross examination. The tumor at renal sinus was considered to arise from the outer layer of the renal pelvis or from the blood vessel in the connective tissues at renal sinus. The tumor at renal hilus was considered to arise from the blood vessel in the connective tissues at renal hilus. This appears to be the first reported case as multiple renal leiomyoma in both Japanese and English literatures.

This is a case report on a patient with double cancer of kidney and urinary bladder. The patient was a 65-year-old female, and she was admitted with the chief complaint of gross hematuria and right flank pain. After careful examinations, she was diagnosed with right nonfunctioning kidney caused by invasive bladder cancer. Computerized tomography incidentally revealed a mass in the upper pole of the left kidney. Selective left renal arteriography showed stretched arteries and irregularity and tortuosity of the smaller vessels. She was diagnosed with double cancer of bladder and left kidney. Owing to the damage of the right renal function, left partial nephrectomy, total cystectomy, right nephroureterectomy and left ureterocutaneostomy were performed. According to DMSA scintigraphy measured 15 days later, the uptake value of the left kidney was 13.25%, compared to the preoperative value of 25.62%. To date, this case is 36th reported case in Japan.

We quantitatively evaluated total and individual renal function by technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renal scintigraphy before and after radiofrequency ablation (RFA) of renal tumors. Eleven patients who underwent Tc-99m MAG3 renal scintigraphy 1 week before and after RFA were evaluated (7 men and 4 women ; age range : 23-83 years ; mean age : 60.6 years). Five patients had solitary kidneys, and five had normally or minimally functioning contralateral kidneys. One patient had a renal cell carcinoma in the contralateral kidney. One patient with a solitary kidney underwent RFA a second time for a residual tumor. In patients with a solitary kidney, MAG3 clearance decreased after 5 of 6 RFAs, and in patients with a normally functioning contralateral kidney, MAG3 clearance decreased after 4 of 5 RFAs, but no significant differences were observed between before and after treatments. In addition to the total MAG3 clearance, the split MAG3 clearance was evaluated in patients with a normally functioning contralateral kidney. MAG3 clearance decreased in 4 of 5 treated kidneys, while it adversely increased in the contralateral kidneys after 4 of 5 RFAs. No significant differences, however, were observed between before and after treatments. The results of our study revealed no significant differences in sCr, BUN, CCr, or MAG3 clearance between pre- and post-RFA values. These results support data regarding the functional impact and safety of renal RFA in published reports. We evaluated total and individual renal function quantitatively using Tc-99m MAG3 renal scintigraphy before and after treatment. This scintigraphy was very useful in assessing the effects of RFA on renal function.

A 56-year-old male presented with a history of dull pain in the abdomen, accompanied by anorexia and weight loss. On examination, he had a moderate tenderness in the right kidney region. Radiological investigation could not deny renal tumor, and the right kidney was removed. Microscopically, characteristic colonies of actinomyces were seen. Preoperatively it is difficult to differentiate renal actinomycosis and renal tumor. Removal of the involved kidney followed by appropriate antibiotic therapy may be promptly curative.

A case of renal tumor with secondary erythrocytosis and acute occlusion of the left common iliac artery is reported. The patient was a 73-year-old male who complained of right upper abdominal pain. Laboratory investigation at admission revealed erythrocytosis. Radiological examinations including excretory urography, angiography and computed tomographic (CT) scan showed that the hypervascular tumor was related to the right kidney with pulmonary metastases. Transabdominal echography revealed a tumor thrombus in the inferior vena cava. The tumor was not surgically removed, and IFN-alpha (HLBI) at a dose of 3 x 10(6) units was administered intramuscularly for 6 consecutive days every week and UFT at a dose of 3 capsules was given by oral route daily. About two months later, acute occlusion of the left common iliac artery with necrosis of the left toes occurred, and the left lower extremity was amputated. The high haematocrit resulted in an increase of blood viscosity which caused acute arterial occlusive disease. The association between renal tumor and erythrocytosis is discussed.

進行性尿路腫瘍8例にIL-2を投与し, その抗腫瘍効果, 副作用などにつき検討した.1) IL-2を28日以上投与しえた5症例のうち, 1例に膀胱癌の肝転移巣の50%以上の縮小を認めた.さらに他の1例にperformance statusの著明な改善を認めた.2) IL-2投与中に, 患者の末梢血NK, LAK活性の上昇傾向を認めた.3)主な副作用として, 発熱, 精神障害, 低血圧, 好酸球増多などを認めた.重篤な副作用として, 心不全, 腎機能障害も認められた, Eight patients with advanced cancer of the urinary tract were treated with recombinant interleukin-2(IL-2) at our department between December, 1985 and September, 1987. Patients were given 5 x 10(5)-4 x 10(6) units of IL-2 by intravenous drip infusion daily. One of five patients who received IL-2 for over 28 days showed 62% regression in size of hepatic metastasis of bladder cancer on computed tomography and another showed marked improvement of Performance Status. The upward tendency of natural killer and lymphokine-activated killer activity of peripheral blood was observed during treatment. Fever, mental disturbance, hypotension and eosinophilia and others were recognized during administration of IL-2, and cardiac failure and disturbance of renal function were also recognized as severe side effect.

We describe a 37-year-old female with bilateral renal angiomyolipoma. She visited the Emergency Department at our hospital because of right severe flank pain. Computed tomography (CT) disclosed a bilateral renal tumors with fat components and high density lesions compatible with a hematoma. Conservative treatment was started, resulting in the improvement in laboratory findings and symptoms. Needle biopsies were performed under the guidance of ultrasonography. The histology was renal angiomyolipoma. She has been receiving a follow-up study at our out-patient clinic with an uneventful course.

Case 1: A 56-year-old man visited us complaining of gross hematuria. Because of his refusal to undergo a surgical operation, we performed embolization and chemotherapy, which were ineffective and he died of cancerous cachexia. Case 2: A 59-year-old female with microscopic hematuria was referred to our clinic. Left partial nephrectomy and right radical nephrectomy were done in a two-stage operation at a 3 month interval. She is now well without sign of recurrence at 9 months after the last operation.

A rare case of primary papillary adenocarcinoma of the renal pelvis is reported. A 75-year-old man was introduced to our institute because of chance hematuria. He had no history of urolithiasis or urinary tract infection. Excretory urography showed a space taking lesion at the lower position of left renal pelvis with low function. Because of advanced stage with paraaortic lymphnode invasion, simple nephrectomy followed by irradiation and systemic chemotherapy with 5-FU was done. He died of pneumonia and acute heart failure after subtotal gastrectomy for peptic ulcer four months after the nephrectomy. Excised specimen revealed papillary adenocarcinoma of the renal pelvis without mucin production. This case was the 51st case reported in the literature. A short review of the disease is also reported.

A case of giant renal hamartoma considered as congenital mesoblastic nephroma in an adult is reported. A 24-year-old woman was admitted to our hospital with complaints of macroscopic hematuria and left flank pain. On clinical examination, a large left renal tumor was recognized and radical left nephrectomy was performed. The tumor weighed 2, 500 g. On histological examination, the tumor was composed of spindle-shaped cells, that were considered as fibroblasts, surrounded by abundant collagenous interstitial material, and many cystic or tubular structures lined by cuboidal epithelium were also seen in the peripheral region. Because of histological similarity we considered this tumor as congenital mesoblastic nephroma in an adult.

1)腎癌の有転移, および無転移症例, 各15例, 計30例につき, 術前および術後の血清蛋白の変動を, 45種類の蛋白分画について, SRD法により測定した.2)術前より, Hx, C4, C3, Znα2, ClsIの高値を示す症例には, 術後, 高率に遠隔転移が認められた.3)有転移症例では, 術後もα1AT, α1AG, α1X, α2HS, Hp, Cp, C9, C5, β2III, C3PAの高値が認められた.4)有転移症例では, 術後もPre, Albの減少状態が持続した.5)有転移症例で, Fibronectinの低下が認められたことにより, 癌組織内でのfibrin沈着やfibrinogen代謝の亢進が示唆された, Using a micro-single radial immunodiffusion method, quantitative studies have been made on the serum proteins of 30 renal cancer patients; 15 patients without metastasis and 15 patients with metastasis, and expressed by percentage of those obtained on 98 normal volunteers regarded as 100%. Of 45 proteins studied, 4 (Pre, Alb, alpha 2HS and Tf) significantly decreased and 10 (alpha 1AT, alpha 1AG, alpha 1X, Hp, Cp, C9, C5, beta 2III, C4 and C3PA) significantly increased before nephrectomy in both patient groups. In postoperative follow-up studies of the non-metastasis patient group, Pre, Alb and alpha 2HS increased, while alpha 1AT, alpha 1AG, Hp, C9, C5, beta 2III, C4 and C3PA decreased, and normal levels were attained within 6 months after nephrectomy. In the metastasis patient group, no significant changes of these serum proteins were observed. Serum proteins showing significant difference between the 2 patient groups were more prominent 6 months after nephrectomy, namely, the majority of the dysproteinemia caused by the presence of renal cancer did not disappear even 1 month after extirpation of the tumor. alpha 1AT was normalized 1 month after nephrectomy at a highly significant difference, P less than 0.001, and considered one of the promising proteins in terms of clinical course evaluation. As a new finding, renal cancer group with metastasis showed a decrease of FN postoperatively suggesting increase of a fibrin deposition and fibrinogen metabolism in cancer tissue.

1)1976年から10年間に腎腫瘍50例, 腎盂腫瘍25例, 尿管腫瘍32例を経験した.2)好発年齢は腎腫瘍は50～60歳代, 腎盂・尿管腫瘍60～70歳代, いずれの腫瘍も男に多く, 腎腫瘍は左右同数で, 腎盂・尿管腫瘍はやや左側に多かった.3)初発症状は, 肉眼的血尿が最も多かったが, 腎盂・尿管腫瘍においては腎腫瘍よりも高頻度であった.4)組織型は, 腎腫瘍ではclear cell typeが最も多く, 腎盂・尿管腫瘍では移行上皮癌が大半を占めていた.5)実測5年生存率は, 腎腫瘍48.1%, 腎盂腫瘍37.9%, 尿管腫瘍31.8%であった.6)いずれの腫瘍も, high grade, high stageの群はlow grade, low stageの群に比して予後不良であった.7)上部尿路悪性腫瘍における赤沈値, 腎腫瘍における摘出重量, 腎盂・尿管腫瘍における尿細胞診, DIP所見などは, 予後を占うパラメーターとなり得る, A clinical survey was done on 107 patients with malignant tumor of the upper urinary tract (50 renal tumors, 25 renal pelvic tumors, 32 ureteral tumors) treated at our Department during the last 10 years (1976-1985). All types of tumors occurred more frequently in males than in females. The age groups of patients in which renal, renal pelvic and ureteral tumors were seen most frequently were those in their sixties, sixties and seventies, respectively. The most frequent primary symptom in patients with these three tumors was gross hematuria. The 5-year actual survival rate for the patients with renal, renal pelvic and ureteral tumors was 48.1, 37.9 and 31.8%, respectively. For all 3 kinds of tumors, the prognosis of patients with high-grade and high-stage cancer was worse than that of patients with low-grade and low-stage cancer. One-hour erythrocyte sedimentation rate for all the tumor types, weight of resected kidney in the case of renal tumor, and the class of urinary cytology and drip infusion pyelography findings in the case of renal pelvic and ureteral tumors were considered to be the factors possible influencing prognosis.