腎盂原発と考えられた癌肉腫の1例

Abstract

The first case of carcinosarcoma originating from the renal pelvis in Japan is reported. A fifty-five year old woman was admitted to the hospital on July 13, 1987, complaining of a one-year history of lumbago. On physical examination, a mass of child's head size was palpable in the right loin. There were other palpable masses in the posterior head (8 x 8 cm), left anterior chest (3 x 3 cm) and sacral region (3 x 3 cm). A chest X-ray showed multiple pulmonary metastases and an excretory urogram revealed a non-visualizing right kidney. Computed tomogram and renal angiogram suggested right renal tumor. Right renal arterial embolization with ethanol sclerosing was performed. She had previously undergone biopsy of the sacral lesion at another hospital, histological examinations of which pointed to suspected carcinosarcoma. She was treated by a combination chemotherapy with vincristine, adriamycin and cyclophosphamide. Despite one course of chemotherapy, her general condition deteriorated with progression of metastatic lesions in the regions other than the lungs. She died of the disease on december 9, 1987. Autopsy was performed. Sections of the right kidney showed a transitional cell carcinoma in-situ with squamous and glandular differentiation in addition to the chondrosarcoma. The metastases were found in the liver, lung and bone, all of which consisted of chondrosarcoma. On the other hand skin metastases consisted of both carcinomatous and sarcomatous elements. The pathological specimens were reviewed at the Armed Forces Institute of Pathology, Washington, D.C.