肉腫様変性を認めた腎盂尿路上皮癌

A case of renal pelvic urothelial carcinoma with sarcomatous change

64歳，男性。腹痛にて当院を受診。腹部CT，腹部MRIで左腎上極に直径10cm大の充実性腫瘍と腹部大動脈周囲リンパ節腫大を認めた。腎細胞癌の術前診断のもと，経腹膜的腎摘除術を施行した。病理学的に尿路上皮癌および肉腫様の紡錘状異型細胞の増殖を認め，肉腫様変性した腎盂尿路上皮癌，臨床病期pT4N1M0と診断した。手術から4か月後，再発により死亡している。

　A 64-year-old man was referred to our hospital with a chief complaint of abdominal pain. Abdominal computerized tomography（CT）and magnetic resonance imaging（MRI）showed a solid tumor 10 cm in diameter at the upper pole of left kidney, with para aortic lymph node swelling. He underwent radical nephrectomy under the diagnosis of renal cell carcinoma. The histological examination reveled a sarcomatous spindle cell carcinoma consisting of urotherial carcinoma. The pathological diagnosis was urothelial carcinoma with sarcomatous change of left pelvis, pT4, grade 3. The patient died from recurrence 4 months after the operation.