マイクロ波組織凝固が腎腫瘍核出術に有用であったVon Hippel Lindau病の1例

Abstract

37歳男.主訴は右腎腫瘍.Von Hippel Lindau(VHL)病で経過観察中, 33歳時に左腎腫瘍の診断で左腎摘除術を施行した.その後, CT上右腎に腫瘍を認め, 精査加療目的で入院となった.腹部造影CT上, 右腎中部に径0.9cm及び1.3cm, 下極に径2.0cm, 計3個の腫瘍を認め, 各々内部が不均一に造影された.右腎造影では, CTと同部位に濃染像が認められた.右腎細胞癌と診断し, microwave tissue coagulatorを用いて右腎腫瘍核出術を施行した.病理組織所見で核異形は軽微で, 管状から索状の形態をとる, clear cell carcinoma G1であった.切除断端は陰性であった.術後, 腎機能の低下は認めず, その他の合併症も認められなかった.現在術後2年を経過したが再発の所見は認められない

The patient was a 37-year-old man who had undergone left nephrectomy under the diagnosis of left renal cell carcinoma associated with von Hippel-Lindau (VHL) disease 4 years ago. Computed tomography (CT) revealed 3 individual tumors 20 mm, 13 mm and 9 mm in maximum diameter in the right kidney. All three renal tumors were enucleated with a microwave tissue coagulator (MTC) without renal pedicle clamping. There were no major complications related to nephron-sparing surgery such as postoperative bleeding, persistent urine leakage and deterioration of renal function. Our findings suggest that renal tumors with VHL disease can be enucleated using a MTC safely and successfully without damaging renal function.