腎盂, 尿管に同時に発生した癌肉腫の1例

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89歳男.肉眼的血尿が出現し,排泄性尿路造影,逆行性尿路造影,腹部CTなどで左尿管腫瘍と診断,シスプラチン併用放射線療法を施行し,いったん腫瘍縮小,血尿が改善したが再発した.排泄性尿路造影で左腎のやや描出不良,逆行性尿路造影で水腎症,下部尿管陰影欠損を認めた.また,左尿管尿細胞診はクラスIV,腹部CTで左水腎症と左下部尿管壁肥厚を認めた.腫瘍による血尿が著明でコントロール困難なため左腎尿管摘出術を施行した..腎盂腫瘍はpT3,尿管腫瘍はpT1の癌肉腫で手術経過は良好で血尿は消失し,術後1年5ヵ月経過観察中で転移,再発は認めていないWe report a case of carcinosarcoma of the renal pelvis and ureter arising in an 89-year-old man who presented at our hospital with gross hematuria. Abdominal computed tomography, excretory pyelography, and retrograde pyelography demonstrated that left hydronephrosis was caused by an ureteral tumor. Left urine cytology indicated transitional cell carcinoma. The patient underwent chemotherapy and radiation therapy. However, gross hematuria recurred, and the patient underwent left nephroureterectomy. The surgical specimen showed carcinosarcoma in the renal pelvis and ureter histologically. He has been free of cancer for 1.5 years.