Sugita Yosuke, Sakaguchi Hisashi, Ito Noriyuki, Yano Keita, Hori Yuki
Department of Cardiovascular Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, JPN.
Department of Urology, Japan Red Cross Wakayama Medical Center, Wakayama, JPN.
Cureus. 2025 Jun 9;17(6):e85598. doi: 10.7759/cureus.85598. eCollection 2025 Jun.
An abdominal aortic aneurysm (AAA) concomitant with a malignant renal tumor (RMT) invading the aortic wall is an extremely rare and complex condition. The optimal surgical strategy, including procedure type and sequencing, remains unclear. We report the case of a 48-year-old male who presented to our hospital with general fatigue and significant weight loss and was found to have a 58 mm AAA along with a massive left renal tumor adjacent to the aortic wall. Multidisciplinary discussions were held between the cardiovascular surgery and urology teams. The patient underwent a two-stage surgical approach involving open AAA repair using a bifurcated graft, followed by open radical left nephroureterectomy. Histopathological analysis of the renal tumor confirmed urothelial carcinoma. The postoperative course was uneventful, and the patient was discharged nine days after the urological surgery (28 days after the aortic surgery). Two months later, a pulmonary metastasis was detected. Despite multiple lines of chemotherapy, the disease progressed gradually, and the patient died of respiratory impairment caused by rapidly progressive pulmonary metastases 11 months after the initial surgery. The short-term outcome in this patient was favorable; however, more sophisticated treatment strategies should be developed in the future based on further research.
腹主动脉瘤（AAA）合并恶性肾肿瘤（RMT）侵犯主动脉壁是一种极其罕见且复杂的情况。包括手术类型和顺序在内的最佳手术策略仍不明确。我们报告了一例48岁男性患者，他因全身乏力和显著体重减轻前来我院就诊，检查发现有一个58毫米的腹主动脉瘤，同时在主动脉壁旁有一个巨大的左肾肿瘤。心血管外科和泌尿外科团队进行了多学科讨论。患者接受了两阶段手术，第一阶段采用分叉移植物进行开放性腹主动脉瘤修复，随后进行开放性根治性左肾输尿管切除术。肾肿瘤的组织病理学分析证实为尿路上皮癌。术后过程顺利，患者在泌尿外科手术后九天（主动脉手术后28天）出院。两个月后，检测到肺转移。尽管进行了多线化疗，病情仍逐渐进展，患者在初次手术后11个月死于快速进展的肺转移所致的呼吸功能损害。该患者的短期预后良好；然而，未来应基于进一步研究制定更完善的治疗策略。
