重複腎盂尿管と尿管異所開口を伴った巨大水腎症の1例

33歳女.腹部膨隆を主訴とし, 腹部超音波検査, DIPと順行性腎盂造影, CT, MRI, 膀胱鏡検査等で, 両側重複腎盂尿管の右上半腎より発生した巨大水腎症と術前診断された.腰部斜切開で後腹膜腔に入ると右上半腎所属の尿管は明らかな腎盂尿管移行部狭窄を伴っており, これにより巨大水腎症が発生したと思われた.尿管異所開口の部位は断定できないが, すくなくとも外尿道括約筋群よりも遠位であると考えられた.巨大水腎とその所属尿管は一塊として摘出され, 巨大水腎の内容量は2, 640mlであった.術後1年目のDIPで良好な経過を取っているGiant hydronephrosis is an uncommon clinical entity. Even more uncommon is the association of giant hydronephrosis with a double collecting system and ectopic ureter. Here, we report a case of giant hydronephrosis of the bilateral duplex systems associated with ureteral ectopia. The patient underwent upper pole nephrectomy and upper ureterectomy. To our knowledge, only four similar cases have been reported previously

同一腎に腎細胞癌と腎血管筋脂肪腫を合併した1例

結節性硬化症の合併は認めない.腹部超音波検査にて, 右腎の中部外側に高エコーを呈する腫瘤を, 下極付近に前者よりも更に高エコーを呈する腫瘤と指摘され当科受診.CT, MRI, 血管造影にて, 右腎中部外側の腫瘤は腎細胞癌と術前診断された.1990年3月経腹膜的根治的右腎摘除術を施行, 中部外側の腫瘍は腎細胞癌, alveolar type, common type, clear cell subtype, G1と, 下極付近の腫瘍は腎血管筋脂肪腫と病理診断された.術後経過は良好で, 術後61ヵ月再発転移を認めないCoexistence of renal cell carcinoma and angiomyolipoma in the same kidney is rare. A 54-year-old woman without tuberous sclerosis was admitted for further examination of incidental renal masses on ultrasonography. Computerized tomography revealed a 17-mm high density mass in the mediolateral portion of the right kidney and a 5-mm low density mass near the right lower pole. Because the former mass showed a typical tumor pattern on selective renal angiography and the latter mass was strongly hyperechoic on ultrasonography, a clinical diagnosis of renal cell carcinoma and angiomyolipoma was made. A right radical nephrectomy confirmed the preoperative diagnosis. She has been followed for 61 months with no recurrence