Tsujimura Go, Yamamoto Akinaru, Yamamichi Gaku, Nakata Wataru, Tsujimoto Yuichi, Nin Mikio, Tsujihata Masao, Miwa Hideaki
The Department of Urology, Osaka Rosai Hospital.
The Department of Pathology, Osaka Rosai Hospital.
Hinyokika Kiyo. 2018 Oct;64(10):403-407. doi: 10.14989/ActaUrolJap_64_10_403.
We report a case of renal pelvic cancer found after left renal trauma. A 63-year-old man was admitted to our hospital because of gross hematuria after he had fallen down the stairs two days earlier. He had asymptomatic severe anemia (Hb : 3. 6 g/dl). Abdominal computed tomography (CT) scan revealed bilateral ureteropelvic stones, bilateral severe hydronephrosis and hematoma of the left upper renal pelvis. We diagnosed him with left renal pelvic hemorrhage by trauma, and transcatheter arterial embolization (TAE) was performed. After TAE, gross hematuria improved, but some hematuria continued to be noted. We suspected malignancy, and examined the patient with contrast-enhanced CT, transurethral resection and retrograde pyelography combined with urine cytology in the upper urinary tract, all with no evidence of malignancy. However, four months after the left renal injury, follow-up CT revealed multiple metastatic lesions. We performed a left nephrectomy, and the resulting pathological diagnosis was invasive urothelial carcinoma with squamous differentiation of the renal pelvis. We performed 7 courses of chemotherapy, but the multiple metastatic lesions progressed, and he died of the disease 19 months after the operation.
我们报告一例左肾外伤后发现的肾盂癌病例。一名63岁男性因两天前从楼梯上摔下后出现肉眼血尿入院。他患有无症状的严重贫血（血红蛋白：3.6g/dl）。腹部计算机断层扫描（CT）显示双侧输尿管肾盂结石、双侧严重肾积水以及左肾上肾盂血肿。我们诊断他为创伤性左肾盂出血，并进行了经导管动脉栓塞术（TAE）。TAE术后，肉眼血尿有所改善，但仍持续存在一些血尿。我们怀疑有恶性肿瘤，于是对患者进行了增强CT、经尿道切除术以及逆行肾盂造影并结合上尿路尿细胞学检查，均未发现恶性肿瘤的证据。然而，左肾损伤四个月后，随访CT显示出现多处转移灶。我们进行了左肾切除术，术后病理诊断为肾盂浸润性尿路上皮癌伴鳞状分化。我们进行了7个疗程的化疗，但多处转移灶仍有进展，患者术后19个月死于该疾病。
