右腎盂腫瘤併發對側腎囊腫

Renal Pelvic Tumor Associated with Contralateral Renal Cyst - A Case Report

10.6452/KJMS.199204.0236

陳黎明(Lia-Beng Tan)；康介乙(Chieh-Yi Kang)；嚴孟意(Meng-Yin Yan)；黃偉晃(Wei-Hwang Huang)；陳俊宏(Jiuun-Horng Chen)

gross hematuria ； renal calyceal tumor ； retrograde pyelography

The Kaohsiung Journal of Medical Sciences

8卷4期（1992 / 04 / 01）

236 - 240

繁體中文

患者為74歲女性主訴，最近二年來有全身倦怠及間歇性眼觀血尿，她曾至外面醫院求診在經一系列檢查包括靜注腎盂攝影、腹部超音波及電腦斷層攝影證實為左腎囊腫而僅接受內科治療。由於二年來血尿並無改善而被轉至本院做進一步檢查治療。住院後患者重新接受靜注腎盂攝影、腹部超音波及電腦斷層也證實為左腎囊腫；然而膀胱鏡檢查，卻簽現血尿是從右側輸尿管出口溢出，而逆行性腎盂攝影委現右腎盂有填充缺損的現象。 在右腎盂腫瘤及左腎囊腫的診斷下，我們立即施以右腎輸尿管及部份膀胱切除術以及左腎囊腫切除術。病理檢查證實為中等分化之腎盞移行性上皮細胞癌。我們認為對於一個有不明原因血尿的病患，若靜注腎盂攝影，甚至腹部電腦斷層攝影，僅發現有腎囊腫時，膀胱鏡或逆行性腎盂攝影，仍是不可或缺的檢查項目之一。

A 74-year-old female presented with a two years history of malaise, weakness and intermittent gross hematuria. Two years earlier, left renal cyst had been diagnosed by excretory urography, abdominal sonography and computed-tomography.. Initially she was treated consevatively with oral antibiotics, however medical management had not been successful in improving her condition. Finally she was transfer to our ward for further evaluation and treatment. Cystoscopic examination demonstrated no abnormality, except for bloody urine efflux from the right ureteric orifice.Right retrograde pyegrams confirmed a solitary filling defect in the upper calyx of right kidney. Because of immediate concern for right renal pelvic tumor and contralateral renal cyst, a midline transperitoneal exploration was made. The right nephroureterectomy with cuff of bladder was removed and left unroffing of cyst was carried out. Convalescence was unevenful. The pathologic examination revealed moderately differentiated transitional cell carcinoma of right kidney with a simple renal cyst of left kidney. We suggest that cases with a clinical diagnosis of renal cyst based on the presence of gross hematuria, a normals excretory urogram and computed tomogram, generally require further evaluation especially by cystoscope and retrograde pyelogram to determine the source of bleeding.