腎移植後自己腎に発生した腎細胞癌の2例 - 本邦26例における臨床的検討と文献的考察 -

Abstract

症例1:60歳男.主訴は無症候性肉眼的血尿.慢性糸球体腎炎による慢性腎不全にて血液透析導入し, 献腎移植術を施行されたが, 移植腎機能の低下が進み, 移植腎機能廃絶により血液透析再導入された.無症候性肉眼的血尿が出現し, CTにて直径約3cmの右腎腫瘍が認められ, 腎細胞癌が疑われた.腹部CTにて, 両側腎は後天性嚢胞性腎疾患(ACDK)を示し, 右腎上極に直径約3cmの充実性腫瘤を認め, 内部には不均一な造影効果を認めた.廃絶した自己腎に発生した腎細胞癌と診断し, 経腹的に根治的右腎摘除術を施行した.病理組織診断はrenal cell carcinoma, clear cell type, G2, pTla, INFβV(-)であった.症例2:55歳男.慢性糸球体腎炎による慢性腎不全にて血液透析導入し, 献腎移植術が施行された.術後, S-Crは, 2.3～2.6mg/dlの間を推移していた.定期CTにて, 直径約3cmの左腎腫瘍を認め, 腎細胞癌が疑われた.腹部CTにて, ACDKを示し, 左腎上極に直径約3cmの充実性腫瘤を認めた.廃絶した自己腎に発生した腎細胞癌と診断し, 経腰的に根治的左腎摘除術を施行した.病理組織診断はrenal cell carcinoma, clear cell type, G2, pTla, INFα, V(-)であった

Renal transplant recipients have an increased risk of developing malignancies due to long-term immunosuppression. Two cases of renal cell carcinoma arising from the native kidney following renal transplantation are reported. Case 1; A 60-year-old man underwent cadaveric renal transplantation on July 31, 1995. He had resumed hemodialysis because of graft failure on June 5, 2000. He was referred to our hospital with macroscopic hematuria on March, 2002. Computed tomography (CT) demonstrated a right renal mass of about 3.0 cm in diameter with bilateral acquired cystic disease of the kidney (ACDK). The radical nephrectomy was performed. Case 2; A 55-year-old man underwent cadaveric renal transplantation on November 15, 1996. He had resumed hemodialysis because of graft failure on June 5, 1996. A left renal mass measuring 3.0 cm in diameter as well as bilateral ACDK were found by CT on July, 2002. Left radical nephrectomy was performed. The histological diagnosis of both renal tumors was renal cell carcinoma, clear cell type, G2, pT1a. Fifty-six renal transplantations (48 were renal allografts from cadavers, while 8 were from living donors) were performed in our hospital from 1980 to 2002. Two patients (3.6%) developed renal cell carcinoma after transplantations. We also discuss a clinical study and review of 26 cases reported in Japan. Since the incidence of malignant neoplasia is high, CT and ultrasonography should be performed routinely on the patients with renal transplantation.