文章詳目資料

中華民國泌尿科醫學會雜誌

  • 加入收藏
  • 下載文章
篇名 Adenocarcinoma of the Renal Pelvis: A Case Report and Emphasis on Difficulty in the Diagnosis
卷期 6:1
並列篇名 腎盂之腺癌-一病例報告並強調其診斷之困難
作者 黃合富楊文洲張維基
頁次 41-44
關鍵字 腎結石腎盂腺癌體外震波碎石術經皮腎臟取石術Kidney calculrenal pelvic adenocarcinomaextracorporeal shock wave lithotripsypercutaneous nephrolithotomyTSCI
出刊日期 199503

中文摘要

一個60歲的男性病患曾因左腎結石在外院做過左腎切開術(nephrolithotomy)。在手術三個月後,開始有間歇性左側腰痛及肉觀性血尿發生。於本院電腦斷層檢查發現左腎有明顯的積水現象及腎盂內有許多斑駁狀的軟組織病變。在腎盂腫瘤的診斷下,病人接受全腎臟切除及輸尿管全切除術。病理切片檢查結果是腎盂之腺癌併有腎周圍組織的侵犯。由這個案例之研究及文獻之回顧我們提以下幾個重點:一、腎臟腫瘤有可能發生於一個腎結石的病人,尤其是牽涉有以下情形:長期尿路阻塞、反複性腎盂炎、時間長久的大結石。儘管體外震波碎石單一療法或合併使用經皮膚腎臟取石術(percutaneous nephrolithotomy)在治療大腎石或療角石上很受歡迎,對於有上述情況的病人及有可能發生腫瘤的考量之下,手術治療應該列入考慮。二、因為這種腫瘤的肉觀結構表現可能是隱藏的或者很像發炎的黏膜,肉眼辨識不易。因此建議對這類病人施行手術時,應常規性地做腎盂黏膜冷凍切片病理檢查。最後我們強調:一個敏銳的懷疑心加上早期診斷、及早期治療對於此種種瘤治療之結果是最重要的。

英文摘要

A 60 year-old male patient who had undergone left nephrolithotomy for left renal stone outside, then complained that intermittent left flank pain and episodes of gross hematuria occurred three months after the operation. Computed tomography revealed maked left hydronephrosis and multiple plaque-lke soft tissue masses along the renal pelvic wall. Total nephrectomy and total ureterectomy were done, and the pathological examination revealed adenocarcinoma of the renal pelvis with perirnal invasion. The mucin stain was positive. A study of this case and review of the literature provided several clinical implications. First, a tumor will possibly develop in a patient with renal calculi associated with the following conditions: long-standing obstruction, recurrent pyelonephritis or a large stone for a long time. In this situation, the possibility of developing a tumor should probably be a significant factor in consideration of selecting surgical treatment for this patient, although extracorporeal shock wave lithotripsy (ESWL) monotherapy or combined with percutaneous nephrolithotomy has been popular in treating staghorn stones. Second, since the gross structure of this tumor may appear to be occult or like inflammatory mucosa, routine frozen biopsy of the renal pelvic mucosa is recommended. Finally, the importance of a keen suspicion, early diagnosis and early treatment are emphasized as means to improve the tumor outcome.

相關文獻