腎部分切除を行った腫瘍内大量出血を伴う腎血管筋脂肪腫

A Case of Renal Angiomyolipoma (AML) with Massive Intra-tumor Hemorrhage Treated by Partial Nephrectomy

　症例は結節性硬化症のある21歳，男性。約4年前から腹部腫瘤を自覚していたが，膨満感が増強し，当院を受診した。各種画像診断により，両腎に多発する血管筋脂肪腫および腫瘍内大量出血が疑われた。栄養血管の選択的塞栓術施行後，左腎部分切除術を行ったところ，陳旧性の血液が約6,000ml貯留していた。腎血管筋脂肪腫に対して近年，塞栓術や腎温存手術が普及しているが，大量出血の合併や巨大腫瘍で腎を温存したという報告はまだ少ない。

A 21-year-old man with a personal history of tuberous sclerosis had been experiencing abdominal fullness for four years. Several imaging studies revealed bilateral multiple renal AMLs and one giant hemorrhagic cyst arising from an AML of the left kidney. He underwent selective arterial embolization twice at one year interval for repeated bleed-ing from AML. However, the third hemorrhage occurred and then we performed the third selective arterial emboliza-tion followed by partial nephrectomy. Approximately 6,000g of blood coagula and old blood were removed during the operation.