비뇨기과 case presentation 전남대학교 의과대학 4학년 112번 정 아 리
정 O 옥 (57/M) C/C Left flank pain with gross hematuria (Duration 2 years) P/H No Hx of DM,HTN,Hepatitis,Pul.Tbc No Op Hx
P/I 상기 환자 2년전부터 Lt. flank pain with gross hemarturia 있다가 최근 severe pain aggravation 되어 F/E & treatment 위해 내원
Lab. s-Cr 1.4 <U/A> RBC 100이상 WBC 30-39
Local IVP
Local CT-non enhanced
Local CT-enhanced
Cystoscopy (2004-5-19) relatively normal mucosa B.U.O : clear urine jet Cytology benign atypia
RGP (2004-5-19)
Operation 2004-6-8 Laparoscopic nephroureterectomy with bladder cuff excision operation findings; - 5.3*4 c m sized mass in renal pelvis - 1.5*1 c m sized mass at ureter ( 4 c m distal from Kidey)
Biopsy trasitional cell carcinoma
Transitional cell cacer of the renal pelvis primary renal cancer의 9% smoking, 중년여성, 정신병의 병력, 만성 두통으로 수년간 3kg이상의 진통제 (phenacetin)을 복용했던 경우 호발 Painless gross/microscopic hematuria(>60%)
진단 (1) IVP * RCC 의 IVP소견과 감별 필요* obstructed, poorly fuctioning, nonvisualized, filling defect in a visualized kidney (2) postive urine cytology (3) cystoscopy, RGP
치료 1. Low-grade, low-stage -> conservative Tx ; local excision & renal parenchyma 보존 2. High-grade, high-stage -> radical nephroureterectomy & bladder cuff excision
Thank you