反応性胸水を伴った後腹膜脂肪肉腫の1例

Abstract

58歳男.主訴は体重増加, 浮腫.右後腹膜腫瘍, 両側胸水が認められ, 左胸腔穿刺施行し, 排液が持続した.CT・細胞診では胸腔内に悪性腫瘍を認めず, 胸水の原因疾患は特定できず, 精査加療目的に当院転院となった.腹部CTで右Gerota's fascia内に11×9×9.5cm大の腫瘍を認め, 内部は不均一で, 一部に脂肪成分と思われる低吸収域を認めた.腹部MRIではT1強調像で等信号・T2強調像で高信号の充実成分の分葉状腫瘤として描出された.右後腹膜悪性腫瘍を疑い, エコー下に右後腹膜腫瘍針生検を施行した.Liposarcomaまたはmyxomatous malignant fibrous histiocytomaとの病理学的診断が得られ, 右後腹膜腫瘍, 右腎合併摘除術を施行した.病理学的所見より高分化型脂肪肉腫と診断した.術後, 胸水は減少傾向にあり, 浮腫も消失し, 術後16日目軽快退院した

A case of retroperitoneal liposarcoma with reactive pleural effusion is reported. A 58-year-old male who complained of weight gain and edema had visited another clinic in May, 2002. Computed tomography revealed a retroperitoneal tumor, 11 x 9 x 9.5 cm in size, surrounding his right kidney and bilateral pleural effusion. Complete resection of the tumor and right kidney was performed with a transperitoneal approach. Though the tumor was limited within Gerota's fascia, we noted two liters of abdominal ascites. Surgical specimen was histologically diagnosed as well differentiated liposarcoma. The post operative course was uneventful. The pleural effusion disappeared, and serum total protein level was normalized. He has remained free of disease for one year.