上皮と平滑筋よりなる腎過誤芽腫 -自験例と本邦113例の腎過誤腫性腫瘍報告例との比較-

Abstract

A case of renal hamartoblastoma found in a 31-year-old woman was reported. She was admitted to our clinic with chief complaint of proteinuria. Physical examination revealed a large palpable left renal mass. Laboratory examinations were not marked except for proteinuria. The patient had no evidence of tuberous sclerosis. On excretory urography, the right kidney was normal but the left had no function. Left renal angiography showed a large avascular area from the middle porticn to the lower pole of the kidney. At transperitoneal right nephrectomy, the kidney was large, irregular in shape and contained numerous cysts. Microscopically, the tumor consisted of epithelial element and smooth muscle tissue with slight atypia. This case was diagnosed as hamartoblastoma both clinically and histopathDlogically. A comparative study was made on this case with 113 reported cases of renal hamartomatous tumors in Japan. These 113 cases were divided into the small and large groups according to their size. It was assumed that the group of small size might correspond to hamartoma and the group of large size to hamartoblastoma. This was not confirmed, however, because of insufficient description of their histolosy. Many cases which should be diagnosed as hamartoblastoma were found among cases reported as hamartoma. Two sarcomas which originated from hamartomatous tumors were included in the series. There were five cases (including this case) of hamartomatous tumors which consisted of both epithelial and non-epithelial components. Clinical findings, diagnosis and therapy of this series were discussed. Finally, an emphasis was made on importance and necessity to differentiate hamartomatous tumors into three categories, that is, hamartoma, hamartoblastoma and carcinoma or sarcoma originating from hamartomatous tumors.