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T4腎細胞癌症例15例を対象とした。1)男女比は4:1, 平均年齢は63.9歳, 患側は右4, 左11で, 浸潤臓器は膵が15例中8例を占めていた。2)検査所見では, 赤沈, α-2globulin, CRPなどの予後因子が高率に異常値を示した。15例中11例に遠隔転移あるいはリンパ節転移を認めた。3) T2およびT3全症例に比べT4全症例は有意に予後不良であったが, 手術施行例だけでは両者間に有意差はなかった。4) 15例中6症例に他臓器合併切除を含めた腎摘除術を施行し, 2症例は3年以上生存した。この2症例はいずれもslow typeで遠隔転移およびリンパ節転移を認めず, PSが良好な症例であった。以上より, T4症例に対する手術適応の決定には, 臨床検査所見, 転移の有無, PSの3因子が重要な要素となる, We studied 15 patients with renal cell carcinoma invading adjacent organs (stage T4) between January 1980 and December 1991. Such invasion was four times more frequent in males than in females. The patients were between 41 and 78 years old, with a mean age of 63.9 years. The tumor was on the right side in 4 cases, and on the left side in 11 cases. Six patients (40%) presented with flank pain. The pancreas was the organ involved most frequently. Eleven patients had regional lymph node involvement or distant metastasis. Most patients had an increased erythrocyte sedimentation rate (ESR), elevated alpha-2 globulin levels, and positivity for c-reactive protein (CRP). In 6 patients, nephrectomy was extended to the abdominal or retroperitoneal structures that seemed to be invaded by tumor. Patients with T2 or T3 tumor had a significantly longer overall survival than patients with a T4 tumor. However, there was no significant difference in survival between T2/T3 tumors and T4 tumors in nephrectomized patients. Two patients who survived longer than 3 years showed no abnormalities of ESR, alpha-2 globulin and CRP. They also had no nodal or distant metastases, and had a good initial performance status. These findings suggest that extended local resection can improve the survival and quality of life for selected patients with T4 tumors.

49歳男, 41歳男, 及び41歳男の計3例で肉腫様腎細胞癌を経験したが, 全例入院時, 側腹部痛, 胸部痛, 全身倦怠感の様な症状があり, 腎摘除術が行われた.2例は術後1年以内に転移により死亡したが, 1例は術後7ヵ月の現在転移・再発なしに生存している, We report 3 cases of sarcomatoid renal cell carcinoma, which is an uncommon neoplasm consisting of a typical renal cell carcinoma associated intimately with a sarcomatoid component. All patients were symptomatic at hospitalization and underwent nephrectomy. Two patients died of metastatic renal cancer within a year, and another is alive without evidence of metastasis for 12 months after the surgery. Because sarcomatoid renal cell carcinoma has a highly malignant behavior and poor prognosis, an adjuvant treatment effective in controlling the disease is awaited.

1) 1988年1月より1989年4月までの37例の腎癌患者の術中出血量および輸血量の検討より, 腎癌手術の自己血貯血量は600 mlが適当と考えられた.2) 1989年5月より1990年7月の間に15例の腎癌患者に対して自己血輸血による根治的腎摘除術を施行した.5例は輸血なしに, 7例は自己血輸血のみにより手術が行われ, 自己血輸血のほかに同種血輸血を必要としたものは3例であった.3)もどし採血法による貯血式自己輸血法では, 1週間で600 mlの採血が可能であり, 進行例の2症例以外は, 血中ヘモグロビン値の2.0 g/dl以上の変化は見られなかった, We studied the possibility of performing radical nephrectomy with only predeposit autologous blood transfusion in the treatment of patients with renal cell carcinoma. A total of 15 patients who ranged in age from 32 to 69 years and had a hemoglobin concentration of over 12 g/dl on admission underwent radical nephrectomy with preoperative autologous blood donation. Five patients did not need transfusions. Seven patients were transfused only autologous blood. The other 3 required some homologous blood in addition to their own banked blood. In our series, patients were able to donate 600 ml of blood during the last week before surgery and their hemoglobin concentration did not decrease by over 2 g/dl except in the case of two patients with advanced disease. Therefore, it was concluded that an adequate autologous blood volume for nephrectomy was 600 ml and that 80% of renal cell carcinoma surgery could be performed without homologous blood transfusion. For patients requiring resection of renal cell carcinoma, autologous transfusion is recommended as safe and convenient.

1)対照群43人の尿中EGF排泄量(平均値±SD)は, 11.7±7.0 ng/mg・creatinine (CRNN)であり, EGF排泄量と年齢との間に有意な負の相関があった.EGF排泄量は男性対照群で9.9±6.0 ng/mg・CRNN, 女性対照群で16.3±7.6 ng/mg・CRNNであった.2)腎癌患者14例の尿中EGF排泄量は, 15.9±12.0 ng/mg・CRNN, 年齢・性を合致させた対照群のそれは14.5±7.9 ng/mg・CRNNであった.3)膀胱癌患者16例の尿中EGF排泄量は, 9.9±5.6 ng/mg・CRNN, 年齢・性を合致させた対照群のそれは, 11.7±7.0 ng/mg・CRNNであった, We evaluated the concentrations of immunoreactive epidermal growth factor (EGF) in urine samples from 14 patients with renal cell carcinoma, 16 patients with bladder tumor and 43 non-malignant controls by using radioimmunoassay. In the non-malignant controls, urinary EGF excretion significantly decreased with age (r = -0.46, p less than 0.01), and females excreted significantly more EGF than males [16.3 +/- 7.6 and 9.9 +/- 6.0 (mean +/- SD) ng/mg.creatinine; p less than 0.05]. There was no significant difference between urinary EGF excretion in the patients with renal cell carcinoma and non-malignant controls matched for sex and age (15.9 +/- 12.0 and 14.5 +/- 7.9 ng/mg.creatinine). The difference in excretion of EGF between the patients with bladder tumor and non-malignant controls also was not significant (9.9 +/- 5.6 and 11.7 +/- 7.0 ng/mg.creatinine). These findings indicate, that urine EGF has little usefulness as a tumor marker for renal cell carcinoma and bladder tumor.

We report a case of renal cell carcinoma with polymyositis. A 62-year-old female with a diagnosis of polymyositis was referred to our department because of the right renal mass discovered by computed tomography. An ultrasonography and renal angiography showed a solid and hypovascular area at the middle pole of the right kidney. A fine needle aspiration biopsy of the mass was performed and the cytology showed a papillary adenocarcinoma. Therefore, the right radical nephrectomy was carried out and her myopathic symptoms were slightly improved postoperatively. The patient has remained well without recurrence or metastasis for two years.

A case of emphysematous pyelonephritis with septic shock was present in a 58-year-old diabetic woman. The spontaneous production of gas was present within the right renal pelvis in kidney-ureter-bladder X-ray. The patient's condition deteriorated rapidly after admission, became complicated with acute renal failure, disseminated intravascular coagulation and acute respiratory failure. Transurethral drainage of the pelvis using a 6 Fr. UPJ occlusion balloon catheter and endotracheal intubation with respiratory assistance were performed as a life-saving procedure. The optimal therapy with surgical or conservative approach for such a severe condition is discussed. The use of transurethral drainage of pelvis as a non-invasive treatment is suggested.

In August 1987, a 66-year-old man was hospitalized because of macrohematuria and right flank pain. He had undergone resection of middle and lower part of the esophagus with esophagogastrostomy for esophageal carcinoma on April 16, 1984. Computed tomography revealed a solid, irregular, low density area in the upper pole of the right kidney and the right lobe of the liver. Arteriography showed a hypovascular mass in the upper pole of the right kidney, and several small tumor stains in the liver. At cystoscopic examination, the urinary bladder was normal and blood flowing from bilateral ureters was not seen. Cytological study of urine sediment disclosed squamous cell carcinoma. The patient was treated with systemic chemotherapy, but not improved. He died 6 months later, and the autopsy demonstrated widespread metastasis in various organs including the right kidney and liver. No recurrence was found in the residual esophagus. The kidney is the sixth organ of metastasis following the lung, liver, bone, adrenal, peritoneum and mesenterium. Although metastasis to the kidney is relatively common in autopsy, it is uncommon to be manifest clinically.