井上 好子¹, 大井 博通², 亀岡 博³, 小角 幸人⁴, 新名 正己¹, 小椋 直人¹, 藤本 博久¹, 田畑 勉⁵

Yoshiko INOUE¹, Hiromichi OI², Hiroshi KAMEOKA³, Yukito KOKADO⁴, Masami SHINMEI¹, Naoto OGURA¹, Hirohisa FUJIMOTO¹, Tutomu TABATA⁵

¹(蒼) 井上病院臨床検査部, ²大阪逓信病院放射線科, ³(蒼) 井上病院泌尿器科, ⁴大阪大学付属病院泌尿器科, ⁵(蒼) 井上病院内科

¹Clinical Laboratory Department, Inoue Hospital, ²Department of Radiology, NTT Osaka Teishin Hospital, ³Department of Urology, Inoue Hospital, ⁴Department of Urology, Osaka University School of Medicine, ⁵Department of Internal Medicine, Inoue Hospital

キーワード : Double cancer, Ultrasound diagnosis, Renal cell carcinoma, Urachal carcinoma

A 43-year-old man presented gross hematuria and abdominal pain in the suprapubic region. Physical examination uncovered no abnormalities, and all but one of the laboratory values were within their normal ranges; CEA was 2.6 ng/ml. Urinalysis showed microscopic hematuria, and cytology was class Ⅲa. Ultrasonography showed an irregular mixed echo mass 10 cm in diameter at the upper pole of the left kidney, and a cystic lesion at the median region in the lower abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a cystic lesion with a slightly irregular and partially calcined wall in the lower abdomen. Cystoscopy showed a nonpapillary tumor involving the dome of the urinary bladder. Diagnosis was combined carcinomas containing a left renal cell carcinoma and an urachal tumor. The patient underwent left nephrectomy and partial cystectomy with block excision of the entire urachus and umbilicus. Pathologic examination showed a double-cancer combination of renal cell carcinoma and mucinous urachal adenocarcinoma. Urachal carcinoma is an uncommon neoplasm, although it is being reported with steadily increasing frequency. The present case is only the fourth case of double cancer with urachal adenocarcinoma to be reported in Japan, and the first reported combination with renal cell carcinoma. Our statistical study of about 116 reported cases in which diagnostic imaging of urachal carcinomas had been performed in Japan is discussed here.