腎細胞癌の膵転移の1例

A case of asynchronous bilateral renal cell carcinoma with pancreatic metastasis is described. Left nephrectomy and tumorectomy in the right kidney were performed. Solitary metastasis to the pancreas without symptoms was treated by distal pancreatectomy with tumor and splenectomy. Although bilateral renal cell carcinomas were histologically renal cell carcinoma (clear cell subtype, grade 2), the resected pancreatic tumor was renal cell carcinoma with sarcomatoid change. Therefore, the metastatic tumor had a more malignant potential than the primary tumor. The pancreatic metastasis was seen at 6 years 10 months and 2 years 6 months after left nephrectomy and enucleation of the right renal tumors, respectively. The patient is alive without disease and is being treated by alpha-interferon for 12 months after distal pancreatectomy. A careful long-term follow-up of the patient with renal cell carcinoma seems to be necessary

特異な増殖形態を呈した巨大腎血管筋脂肪腫の1例

特異な増殖形態を呈した巨大腎血管筋脂肪腫の1例神戸大学医学部泌尿器科学教室(主任=守殿貞夫教授)郷司和男, 後藤章暢, 守殿貞夫66歳女性に見られた特異な増殖形態を有する巨大腎血管筋脂肪腫の1例を報告する.腫瘍は左腎上極より発生し上方へ増殖し横隔膜を挙上すると共に腎の背側ヘシート状に増殖していた.MRIは本症の診断に有用で腫瘍と周囲臓器との関係を明瞭にすることができた.腎血管筋脂肪腫の診断のもとにCUSAを用いて腫瘍摘出術を施行した.腫瘍は重量1, 380gで弾性硬, 黄色調を呈し, 組織学的に血管筋脂肪腫であった.術後経過順調で術後2年を経たが明らかな再発を認めていない,A case of a giant renal angiomyolipoma with uncommon growth pattern in a 66-year-old female is reported. The tumor originated from the upper pole of the left kidney and simultaneously grew posteriorly in a sheet-like fashion while a spheroid mass projected upwards. With magnetic resonance imaging (MRI), the relationship between the tumor and adjacent organs was clear. Tumorectomy employing cavitron ultrasonic surgical aspirator (CUSA) was performed, and proved to be a safe and simple procedure. There has been no recurrence of the growth 2 years post-operatively

同側腎無形成を合併したCA19-9産生精嚢嚢胞の1例

29歳男, 残尿感, 会陰部痛を主訴として受診.直腸診にて波動を有する前立腺を触知した.MRIでは右腎は欠損し, 同側の精嚢は拡張し嚢胞状変化を伴っていた.経直腸的精嚢穿刺術を施行し, 内容液は血性膿汁であった.初診時, 血清CA19-9が145.8U/mlと異常高値であったが抗生剤投与と穿刺術にて正常化し, 症状も消失したA case of CA19-9-producing seminal vesicle cyst with ipsilateral renal agenesis is reported. A 29-year-old man was admitted to our hospital for perineal pain and urinary retention. Digital rectal examination revealed a large soft mass that fluctuated in the area of the prostate and seminal vesicles. Magnetic resonance imaging revealed a right kidney defect, and ipsilateral dilation and cystic enlargement of the right seminal vesicle. Transrectal puncture of the seminal vesicle cyst was performed. The contents were pus and old red blood cells. Initially, the serum CA19-9 level was extremely high (145.8 U/ml) but was normalized by the treatment with antibiotics after the puncture. The symptoms subsided without recurrence

精索転移をきたした腎細胞癌の1例

患者は56歳, 男性で肉眼的血尿を主訴とし来院した, 諸検査にて下大静脈腫瘍血栓を伴う右腎細胞癌の診断を得, 根治的右腎別除術および腫瘍血栓別出術が施行された.剔除腫瘍は組織学的にrenal cell carcinoma(clearcellsubtype)であった。再発を認めず術後1ヵ月目に退院した。退院後6ヵ月目に陰嚢内の腫瘤にきづき来院し転移性精索腫瘍の診断の下に右精巣摘除術が施行された.腫瘍は右精索に位置し組織学的にはrenal cell carclnoma(clear cell subtype)で腎細胞癌の転移と思われた.自験例は, 腎細胞癌が精索静脈を経て精索に転移をきたしたものと思われた.腎細胞癌では経過観察期間中, 精索も含めた全身的観察が必要である.A 56-year-old male visited our hospital with macroscopic hematuria. Physical and X-ray examinations showed he had right renal cell carcinoma with tumor thrombosis in the inferior vena cava and the right spermatic vein. Radical nephrectomy and tumor thrombectomy were performed and he was discharged with no evidence of disease 1 month after the operation. At 5 months after the discharge, he noticed a palpable mass in the scrotum. Right orchiectomy was performed. The tumor was located in the right spermatic cord and histological examination revealed it to be a renal cell carcinoma (clear cell subtype) which was a metastatic lesion from a right renal tumor. In this case, the renal cell carcinoma was considered to have retrogradely metastasized through the spermatic vein. In conclusion, a complete physical examination, including the spermatic cord is recommended during the follow-up period of renal cell carcinoma

切迫性ならびに腹圧性尿失禁に対するプロビベリンの臨床効果に関する検討

プロピベリン(20mg/日, 28日間)の臨床効果を49名の患者を対象に多施設協同研究で調査した.排尿回数の中等度以上の改善を切迫性及び腹圧性尿失禁で52%及び54%の患者で達成出来た.尿意切迫感はそれぞれ91%及び58%の症例で改善した.尿失禁はそれぞれ97%及び71%の症例で改善した.日常生活の制限はそれぞれ94%及び64%の症例で改善が見られた.軽度の副作用を5名に, 臨床検査値の変動を2名に認めたThe efficacy and tolerability of propiverine hydrochloride (20 mg/day) were evaluated in the treatment of a total of 49 Japanese patients (35 with urge incontinence and 14 with stress incontinence) in an open multicenter trial lasting 28 days. The effects on the frequency of urination, urinary incontinence, urinary urgency, and daily living activities were evaluated through the voiding diaries filled out by the patients. Moderate or greater degree of improvement was attained in micturition frequency by 52 and 54% of the patients with urge incontinence and with stress incontinence, respectively, in urinary urgency by 91 and 58%, in urinary incontinence by 97 and 71%, and in daily living activities by 94 and 64%. Although minor adverse reactions (5 patients) and abnormal values in blood chemistry (2 patients) were recorded in 7 patients, all of these patients completed the trial. These results suggest that propiverine hydrochloride is a safe and effective drug of choice for the treatment of not only urge incontinence but also stress incontinence in patients diagnosed in a clinical setting

ベリニ管由来が示唆された乳頭状腺癌の1例

76歳男, 健康診断のため施行された腹部CTで左腎腫瘍が疑われ根治的左腎摘出術が施行された。摘除腎の髄質に割面黄褐色で直径約2cmの腫瘍を認め病理組織学的に円柱状で好酸性胞体を有する悪性細胞が乳頭状に増殖していた。レクチンおよび2種のモノクローナル抗体を用いた検討では, Soybean agglutinin, Peanut agglutinin, Dolichos biflorus agglutinin, Lotus tetragonolobus agglutininおよびCytokeratinは弱陽性でTamm-Horsfall proteinが陰性であった。腫瘍の肉眼的および組織学的所見は, 本腫瘍がベリニ管上皮由来であることを強く示唆した。患者は手術後1年を経たが腫瘍の再発を認めず健在であるA case of Bellini duct carcinoma is reported. A left renal tumor was detected by abdominal computerized tomography in a 76-year-old male, although he had no symptoms, such as hematuria, weight loss or flank pain. Radical nephrectomy was performed under the diagnosis of renal cell carcinoma in the left kidney. Macroscopic examination of the resected kidney revealed a tumor 2.0 cm in diameter, with a yellow-brown cut surface, located in the renal medulla. Histological examinations showed malignant tumor cells with eosinophilic cytoplasm with a papillary growth pattern. Immunohistostaining examinations using Lectin and two kinds of monoclonal antibodies demonstrated no significant staining with soybean agglutinin, peanut agglutinin, Dolichos biflorus agglutinin, Lotus tetragonolobus agglutinin or cytokeratin, and negative staining with Tamm-Horsfall protein. Although the results of immunohistostaining did not provide support, both macroscopic and microscopic findings strongly suggested that this tumor originated from Bellini duct epithelium (Bellini duct carcinoma). The patient is alive with no evidence of disease 1 year after surgery. Bellini duct carcinoma is a rare malignant condition and the prognosis is usually poor. Differential diagnosis from other renal or pelvic tumors is difficult and long-term careful follow-up is necessary

血清BasicFetoproteinが高値を呈した傍精巣平滑筋肉腫の1例

血清basicfetoproteinが高値を呈した傍精巣平滑筋腫の1例を報告する.患者は45歳男性で6ヵ月前より左陰嚢内容の無痛性腫大を自覚し当科を受診した.左精巣腫瘍の診断の下に左高位除聖術が施行された.肉眼的および病理組織学的所見より摘除腫瘍は傍精巣平滑筋肉腫であった.血清basicfetoproteinは新しく同定された胎児性蛋白で, ある種の悪性腫瘍で高値を示す.自験例では術前血清basicfetoprotelnが高値を示し, その値は患者の病状とよく相関した.化学療法および, 肺転移巣切除にもかかわらず患者の全身状態が悪化するとともに血清baslcfetoprotein値は上昇し, 患者は入院後2年6ヵ月目に癌死した.血清basicfetoproteinは自験例では有用な腫瘍マーカーであると思われた.A case of paratesticular leiomyosarcoma associated with elevated serum basic fetoprotein level is reported. A 45-year-old male visited our hospital with a 6-month history of a painless left scrotal mass. High orchiectomy was performed under the diagnosis of left testicular tumor. Macroscopic and microscopic examination of the resected tumor demonstrated it to be paratesticular leiomyosarcoma. The value of serum basic fetoprotein, which is a newly identified oncofetal protein and useful as a tumor marker in some kinds of malignant neoplasm, was elevated before therapy, and its fluctuation was correlated with his clinical course. In spite of chemotherapy and resection of metastatic lesions in the lung, his condition gradually deteriorate with increasing serum basic fetoprotein level, and he died with carcinomatosis 2 years and 6 months after his admission. We suggest that basic fetoprotein is a useful tumor marker in this disease

総腸骨動脈瘤による尿管狭窄の1例 : 本邦報告例の臨床病理学的検討

A case of right ureteral obstruction secondary to right common iliac aneurysm presenting as right hydronephrosis is reported and the literature is reviewed. A 66-year-old man was admitted to our hospital with lower abdominal pain and was treated by bypass operation with artificial vessel and uretero-ureterostomy of right ureter under the diagnosis of right ureteral stenosis secondary to right iliac aneurysm. Histological examination showed arteriosclerotic aneurysm and a fibrillary inflammatory change in peri-ureteral tissue without any hemosiderin-laden macrophages. Intravenous pyelography showed improvement of right hydronephrosis 45 days after operation. To date 11 cases including our case have been reported in Japan, 10 in males and the other in a female. Initial symptoms were either lumbago or an abdominal mass with palpitation in many cases. The treatment was by resection of aneurysm with bypass grafting or ureterolysis

前立腺癌診断における前立腺特異抗原(PSA)関連パラメーターの有用性の検討 血清PSA値がGray zoneを示す症例

血清PSA値4～10ng/mlを示す症例について前立腺癌診断におけるtotal PSA(tPSA), PSA density(PSAD), free to total PSA ratio(F/T比)の有用性を検討した.1999年5月から2001年4月迄に経直腸的エコー下前立腺生検を施行した43例を対象とし, ROC曲線を用いて各検査法の有用性を検討した.43例中, 前立腺癌:12例(27.9%), 非癌:31例(72.1%).tPSA, PSAD値, F/T比のmean±SEMは癌症例で各々7.308±0.636ng/ml, 0.271±0.039ng/ml/cm3, 16.225±4.911%であるのに対し, 非癌症例は6.300±0.289ng/ml, 0.178±0.020ng/ml/cm3, 15.213±0.980%であった.全症例におけるPSAD, tPSA, F/T比のROC曲線右下部分の面積を比較すると有意差をもってPSADのみが高かった(p<0.05).PSAD値においてcut-off値を0.16ng/mlとすると感度は83.3%, 特異度は71.0%であった.日本人で血清PSA値がgray zoneにある症例においてPSADの測定は最も有用であることが示唆されたTotal serum prostate-specific antigen (PSA) levels, free-to-total PSA ratio (F/T ratio) and PSA density (PSAD) were compared to clarify the clinical significance of these parameters in the diagnosis of prostate cancer (CaP) with intermediate PSA concentrations (4-10 ng/ml). PSAD and F/T ratio were obtained during the period from May 1999 to April 2001 from 43 patients with serum PSA concentrations of 4-10 ng/ml who underwent ultrasound-guided systematic sextant biopsies. PSAD was compared with total serum PSA and F/T ratio via receiver operating characteristic (ROC) curves for diagnosis of CaP. Diagnosis of CaP and non-CaP was made in 12 (27.9%) and 31 (72.1%) of the 43 patients, respectively. Mean serum PSA, PSA density and F/T ratio were 7.308 +/- 0.636 ng/ml, 0.271 +/- 0.039 ng/ml/cm3 and 16.225 +/- 4.911% in patients with CaP and 6.300 +/- 0.289 ng/ml, 0.178 +/- 0.020 ng/ml/cm3 and 15.213 +/- 0.980% in those with non-CaP, respectively. The ROC curve analysis demonstrated that PSAD predicted the biopsy outcome significantly better than F/T ratio and total PSA in all 43 patients (p < 0.05). In distinguishing CaP patients, the cutoff value of 0.16 ng/ml/cm3 for PSAD yielded a specificity level of 71.0% at a sensitivity level of 83.3%. Our study revealed that PSAD is a significant predictor in distinguishing CaP from non-CaP in Japanese men