馬蹄鉄腎に発生した腎細胞癌の1例

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左腎臓腫瘤精査を目的とした69歳男で,CT及びMRI上,馬蹄腎の左側に腎静脈血栓随伴異構造性腫瘤を認めた.大動脈造影では左腎に血管過多腫瘤及び大動脈から分岐し峡部に走る異所性動脈が認められた.峡部で切離し左腎摘除を行った.グレード2,ステージT3bの腎細胞癌であった.腫瘍はないが,術後5ヵ月に脳内出血で死亡したA 69-year-old man presented for further examination for left renal mass. Computed tomography and magnetic resonance imaging revealed a heterogenous mass on the left side of a horseshoe kidney accompanied with renal vein thrombus. Aortography showed a hypervascular mass in the left kidney and aberrant arteries to the isthmus originating from the aorta. A left nephrectomy with the division of the isthmus was performed through an abdominal transperitoneal approach. Histological evaluation revealed grade 2, stage T3b, renal cell carcinoma. The patient was free of tumor, but died of intracerebral hemorrhage 5 months after the operation.