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

血精液を主訴とした精嚢腺筋症の1例

62歳, 男性.血精液を主訴として来院.精嚢炎を疑い抗菌剤投与を行い軽快した。その後再発したため, 尿道膀胱鏡を行ったが異常を認めなかった.精嚢造影では右精嚢は描出されず, CTにて前立腺右背側に内容均一な腫瘤を認めた。経直腸超音波検査にて右精嚢の腫大を認め, 超音波ガイド下生検を行ったところ, 明らかな異常所見をえられなかった.診断目的で手術を行い前立腺および精嚢を摘出した.病理学的診断は精嚢腺筋症であった.A 62-year-old man presented in 1987 with hematospermia. No abnormal findings were observed by cystourethroscopy. Ultrasound showed the enlargement of the right seminal vesicle. The right seminal vesicle could not be visualized by seminal vesiculography. Computed tomographic scan revealed a homogeneous mass at the right dorsolateral aspect of the prostate. Surgical exploration was performed. The prostate and bilateral seminal vesicle were resected. Pathological diagnosis was adenomyosis of the right seminal vesicle

CFTR gene mutations in Japanese individuals with congenital bilateral absence of the vas deferens

AbstractCongenital bilateral absence of the vas deferens (CBAVD) is a monosymptomatic disease confined to the male reproductive system with similarity to the phenotype of cystic fibrosis (CF), and mutations in the CFTR gene are highly prevalent in Caucasian CBAVD patients. While CF is very rare in Japan, CBAVD is not. Our previous study demonstrated high prevalence of the 5T allele in the CFTR gene in Japanese CBAVD patients. We analyzed whole exons of the CFTR gene in 19 CBAVD patients and 53 normal individuals using polymerase chain reaction amplification-single strand conformation polymorphism analysis and direct sequencing. Three missense mutations (W216X, G1349S, Q1352H) were found in seven CFTR alleles, and the 5T allele was positive in 11 of 38 CFTR patient alleles. Consequently, 47% of CFTR chromosomes in the patients were affected, and 11 individuals (58%) had at least one mutated CFTR allele. In contrast, three of 53 normal individuals (5.7%) had a missense mutation in one of the CFTR genes, but no 5T allele was detected (both P<0.0001). Mutations of the CFTR gene are closely associated with Japanese patients with CBAVD

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

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

舌転移をきたした腎細胞癌の1例

We report a case of renal cell carcinoma (RCC) metastatic to the tongue in a 58-year-old female. The patient had undergone radical nephrectomy for renal cell carcinoma 5 years previously, and experienced multiple metastatic disease in lung, bone, and contralateral kidney, before she noticed yellowish tumor on the left border of the tongue. Microscopic appearances of the biopsied lingual tumor were almost identical to those of the primary kidney tumor, thus the diagnosis of lingual metastasis from renal cell carcinoma was established. This case represents the tenth case of RCC metastatic to the tongue

精巣白膜嚢胞の1例

68歳男.正常精巣を圧排するように存在する精巣白膜嚢胞の1例を経験した.組織学的には精巣輸出管由来と考えられる嚢胞であった.このような精巣の良性嚢胞性疾患は, 精巣腫瘍と鑑別する上で重要である.なお, 本症例は治療として高位精巣摘除術が施行されたが, 術前十分な検討のもと良性疾患の診断が行われれば, 精巣温存も可能だと思われたWe describe a patient whose testicular parenchyma was displaced by a cyst. Histologic findings suggested that the cyst was a dilated efferent ductule passing through the tunica albuginea. Such a cyst is an important and benign consideration in the differential diagnosis of testicular masses. Although orchiectomy was performed in this case, early consideration and confirmation of benign lesions may permit testicular preservation

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

遊離回腸を利用した膀胱拡張術後に発生した膀胱腺癌の1例

47歳男子にみられた, 結核性萎縮膀胱に対するU字型遊離回腸移植膀胱拡張術後20年目に同移植回腸上皮より発生したと考えられる膀胱低分化腺癌の1例を報告し, 若干の文献的考察を加えた.This is a report of a case of poorly differentiated adenocarcinoma found 20 years after bladder augmentation ileoplasty. The origin of this tumor was proved to be the ileal part of bladder augmentation. Autopsy revealed metastatic lesions in the stoma (sigmoid conduit), lungs, liver, left femur, adrenal glands and lymph nodes. A review of the literature revealed only one other such case. This is a rare case of adenocarcinoma in the ileal part of bladder augmentation

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