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A 65-year-old man presented to a clinic with a chief complaint of macrohematuria and frequent urination. The computed tomographic scan and cystoscopy revealed a dome of bladder tumor. He was referred to our hospital with the diagnosis of bladder tumor. He had undergone bilateral inguinal hernia repair and magnetic resonance imaging suggested mesh plug migration on the urinary bladder inserted into the right inguinal lesion 11 years previously. Under the diagnosis of mesh plug migration, partial cystectomy with extraction of the foreign body was performed. After the surgery he was well and symptoms had disappeared.

A 79-year-old woman presented with gross hematuria. She had undergone a right radical nephrectomy 2 years previously for G2 pT2 renal cell carcinoma, clear cell variant. Intravenous pyelography showed a filling defect in the left ureter. Systemic work-up demonstrated no evidence of other metastases. Partial uretectomy and end-to-end ureteroureterostomy were performed. Histology showed metastatic clear cell carcinoma consistent with the primary renal tumor. Six months after surgery, her serum creatinine was stable at 1.6 mg/dl and she was doing well without evidence of recurrent disease. Solitary metastasis of renal cell carcinoma to the contralateral renal pelvis or ureter is extremely rare, with only 7 cases having been reported. We herein describe the present case and review the relevant literature.

腎細胞癌と腎盂移行上皮癌の同側性, 同時性重複癌の2例を経験した.症例1(70歳男).膀胱結石術後にて通院中に顕微鏡的血尿を認めた.尿細胞診がclass IVであった.右腎腫瘍, 右腎盂腫瘍の診断で, 右腎尿管摘除術を施行した.術後4年4ヵ月を経過した現在, 局所, 膀胱内再発は認めていない.症例2(54歳男).検診での腹部エコーで左腎外側に径2cm, 左腎盂に径4cmの腫瘤を認めた.逆行性腎盂造影においては左腎盂に不整な陰影欠損を認めた.画像所見上, 他臓器に腫瘍は認めなかった.左腎腫瘍, 左腎盂腫瘍の診断で, 左腎尿管摘除術を施行した.術後9ヵ月を経過した現在, 局所, 膀胱内再発は認めていない, Two cases of synchronous ipsilateral renal cell carcinoma and renal pelvic transitional cell carcinoma are presented, one in a 70-year-old man and another in a 54-year-old man. These two cases were diagnosed preoperatively as synchronous ipsilateral renal tumor and pelvic tumor from urine cytology, retrograde pyelography, computed tomography and magnetic resonance imaging, and in both two cases, nephroureterectomy was performed. Pathological diagnosis was renal cell carcinoma and renal pelvic transitional cell carcinoma, which existed incidentally in the same kidney. To our knowledge, these cases are the 34th and 35th reported cases of synchronous ipsilateral renal cell carcinoma and renal pelvic transitional cell carcinoma in Japan.

60歳男.患者は生体腎移植を希望していたが, 術前スクリーニングを施行したところPSAの高値が指摘された.そのため前立腺癌に対する加療目的で入院となった.肉眼的血尿を訴えたため膀胱鏡を施行したところ, 膀胱右側壁に広基性乳頭状腫瘍を認めた.膀胱洗浄液による細胞診はclass Vであった.膀胱腫瘍に対してTUR-Btを施行し, 病理診断はTCC, G2, pTaであった.前立腺癌については, 膀胱癌の再発がない時期に手術することとなり, CAB療法を開始し, 一旦退院となった.膀胱鏡では膀胱腫瘍の再発を認めず, 膀胱洗浄液による細胞診もclass IIであった.全身麻酔下に恥骨後式根治的前立腺全摘除術が施行され, 術後19日目に経過良好で退院となった.再発の徴候なく, 尿禁制は保たれており, 経過は良好である, A 60-year-old male, who had been maintained on hemodialysis for 4 years, visited our hospital to receive living renal transplantation. He complained of macrohematuria, and preoperative examination showed elevation of psostate specific antigen (PSA). Cystoscopy revealed papillary tumors on the right lateral bladder wall. Transurethral resection of bladder tumor (TUR-Bt) was performed and histopathological examination showed transitional cell carcinoma, G2, pTa. The histologic diagnosis of the transrectal needle prostate biopsy specimen was moderately differentiated adenocarcinoma. Combined androgen blockade as a neoadjuvant therapy and radical prostatectomy were performed. A case of synchronous double primary cancers, comprised of adenocarcinoma of the prostate and transitional cell carcinoma of the urinary blader in a hemodialysis patient has never been previously reported in the Japanese literature.

57歳男性.患者はふらつき及び嘔吐で消化器科を受診し, 超音波検査で左腎下極に10cm大の腎腫瘍と著明な水腎を指摘され, 著者らの泌尿器科へ紹介となった.所見では, CTで左腎に15×10×10cm大の不整形で不均一に造影される腫瘍を認め, 腫瘍の背側には拡張した腎盂が認められた.また, 逆行性腎盂造影では左腎盂尿管移行部の狭窄と著明な水腎を認め, MRIでは全体としてhypervascularなRenal cell carcinoma(RCC)様の腫瘍が認めめられた.更に血管造影では左腎動脈は1本で, 左腎相当部位の下2/3に腫瘍血管の増生とtumor stainを認め, RCCと考えられ, 上1/3には正常実質の染まりを認めず, 水腎部分と考えられた.腎盂尿管移行部狭窄症による高度水腎に発生した腎腫瘍と診断し, 左腎摘除術を施行した結果, 病理診断はRCC, alveolar type, clear cell subtype, G2, pT2であった, A 57-year-old male was referred to our hospital with a complaint of dizziness. Abdominal computed tomography and retrograde pyelography revealed a left renal tumor associated with hydronephrosis due to pelviureteric junction (PUJ) obstruction. A radical nephrectomy was performed and histological diagnosis was renal cell carcinoma. Only five cases of renal cell carcinoma with hydronephrosis due to PUJ obstruction have been previously reported in the Japanese literature.

A 75-year-old man was admitted to our hospital with a complaint of fever and backpain. He was diagnosed with acute pyelonephritis, and was administered an antibiotic. However, since there was no improvement in the symptoms, he was admitted to our hospital. Computed tomography revealed a tumor which was in contact with a thoracic vertebra. Because he had had a total cystectomy for bladder cancer in the past, we suspected a spinal metastasis of urothelial carcinoma. However, after magnetic resonance imaging, we finally diagnosed it as pyogenic spondylodiscitis, and his condition improved after administration of antibiotics.

72歳男。患者は職業性膀胱癌に対しTUR-BTを施行され、以後、外来で経過観察されていた。今回、膀胱鏡にて頂部から前壁にかけて非乳頭状隆起性腫瘤と周囲粘膜の発赤、浮腫を認めた。血液検査ではLDH CRPが軽度高値で、空腹時血糖が124mg/dl、HbA1cが7.5%であった。検尿検査に異常はなく、尿細胞診はクラスIであった。画像所見、検査所見により尿幕管腫瘍を疑い、膀胱部分切除術を施行したところ、病理組織学的所見で腫瘍周囲粘膜には炎症細胞浸潤を認め、腫瘍部位では紡錘形の腫瘍細胞の増生を認めた。以上より、膀胱原発のinflammatory myofibroblastic tumor(IMT)と診断され、追加治療は行わなかった。術後13ヵ月経過現在、再発は認められていない。, Here we report a rare case of inflammatory myofibroblastic tumor of the bladder. The patient was a 72-year-old man. We diagnosed this case preoperatively as urachal tumor from urine cytology, cystoscopy, and magnetic resonance imaging. We performed partial cystectomy. Histopathological examination revealed that the tumor was an inflammatory myofibroblastic tumor. To our knowledge, this is the 51st reported case of inflammatory myofibroblastic tumor of the bladder in Japan. He has been followed up for 13 months without any evidence of local recurrence.