拡大手術を施行した腎浸潤性移行上皮癌

Infiltrating transitional cell carcinoma of the kidney treated by extended nephrectomy

63歳男性が肉眼的血尿で来院。画像上，腎実質および腎周囲組織に浸潤する右腎盂腫瘍と診断した。術中，腫瘍が下大静脈に浸潤していたため腎尿管全摘とともに下大静脈合併切除術も行った。病理組織学的に腎浸潤性移行上皮癌であった。術後，後腹膜腔再発によると考えられるイレウスが遷延し再手術を行った。その後，うつ状態や腸瘻も加わり追加治療を行えないまま術後6か月目に癌死した。

Sixty-three-year-old man,with grosshematuria of four months' duration,was referred to our department. Abdominal ultrasonography suggested right invasive renal pelvic tumor and abdominal CT showed swelling of the right kidney,but renal contour was distinct. MRI demonstrated the tumor invaded the perirenal tissue and attached to vena cava inferior（IVC）. The extended surgery including nephroureterectomy and partial resection of IVC was done. Resected specimen showed the non-papillary tumor diffusely infiltrating the renal parenchyma. Microscopic investigation revealed TCC,G2. About a month after the operation,he underwent the second surgery for mechanical ileus associated with local recurrence. Thereafter,mental depression and development of intestinal cutaneous fistula allowed neither chemotherapy nor radiation. He died of the cancer six months after the first surgery.