腎小細胞癌の1例

Abstract

79歳男.第3度房室ブロックにてペースメーカーを装着した.その後, 前立腺癌にて内分泌療法を行い, 膀胱癌にてTUR-BT後BCG膀胱内注入療法後, 経過観察中であった.右側腹部痛, 食思不振, 血尿を認め, 腹部CTで長径15cmの巨大腎腫瘍を認め, 周囲臓器を圧排し, 大動脈周囲や後腹膜にリンパ節転移を認めた.総腸骨動脈分岐部まで, 下大静脈内に腫瘍血栓を認めた.単純CTでは腫瘍は正常腎組織と同程度の濃度であり, 造影CTでは内部不均一で, 正常腎組織より弱く造影された.局所での進展が強く腫瘍血栓やリンパ節転移も認めたため, 外科的切除術は不可能と判断し, エコーガイド下に腎生検を行った.病理学的に腎小細胞癌と診断され, 計55Gyの予定で放射線療法を始めるも, 12.5Gyで食思不振が更に強くなり中止した.以後, 保存的療法で経過し癌死した

A 79-year-old man presented in August 2002 with right flank pain, anorexia, and gross hematuria. Physical examination was significant for a palpable, nontender, firm, and fixed mass in the epigastric region. Computed tomography scan of abdomen revealed a 15 cm tumor occupying almost the whole right kidney with extension into the inferior vena cava. The para-aortic and retroperitoneal lymph nodes were significantly enlarged. Examinations including bone scintigram and chest X-ray revealed no metastases. The patient underwent a ultrasound sonography-guided biopsy of the renal tumor, which showed a small cell carcinoma pathologically, and immunohistochemically. The patient received palliative treatment, and died in February 2003. We reviewed 25 cases including our case, and analyzed the clinical outcome of small cell carcinoma of the kidney.