A case of primary renal angiosarcoma

A 78-year old man was diagnosed with a left bleeding renal cyst from CT scan results. Serial CT scans revealed the left kidney mass to be increasing in size and a new lesion in the liver. Renal cell carcinoma with liver metastasis was diagnosed and a radical nephrectomy performed. The initial pathological diagnosis was a benign chronic hematoma. However, the liver mass increased in size and multiplied, while another mass emerged in the twelfth thoracic vertebra with spinal paralysis and was immediately removed. Pathological findings for that specimen showed malignancy of stromal cell origin but low atypia. The renal specimen was re-evaluated using whole cross-section analysis and immunohistochemistry, and diagnosed as a primary renal angiosarcoma. Recombinant interleukin-2 therapy was started immediately; however, the patient died of metastatic disease 13 months after the initial operation. Although contrast imaging depicted the primary lesion as a non-specific hematoma with little focal pooling, and low-grade cytological atypia was shown pathologically, the angiosarcoma was extremely aggressive

胆嚢十二指腸瘻による胆石性イレウスの一例

京都府立医科大学附属北部医療センター　外科京都府立医科大学　消化器外科Department of Surgery, North Medical Center Kyoto Prefectual University of MedicineDivision of Digestive Surgery, Department of Surgery, Kyoto Prefectual University of Medicine症例は60歳、男性。腹痛・嘔気を主訴に近医から当院受診となった。CTでは小腸内に結石を認めており、その口側腸管の拡張を認めていたことから胆石性イレウスの診断となった。イレウス管留置を行い保存的加療を継続していたが嘔吐、腹痛ともに改善せず、当院外科で腸閉塞解除術を施行した。術中所見では腸管壊死は認めなかったため結石摘出術のみを施行し閉腹した。高度肥満に対する減量指導を行いながら外来で経過観察し、胆嚢十二指腸瘻閉鎖術を二期的に行う方針となっている