原発性との鑑別が困難であった転移性副腎腫瘍の1例

Abstract

62歳男性.患者は発熱, 全身倦怠感で受診となった.血液検査でWBC, CRPの高値を認め, 腹部造影CTでは右腎上方に5cm大で内部に不均一なlow densityを持つ腫瘍が認められた.さらに造影MRIではT1強調でlow intensity, T2強調で肝に比しhighで内部不均一なsignalを示した.胸部CTでは左肺門部とS6胸膜直下の2ヶ所に腫瘍を認め, 右副腎腫瘍の生検より低分化型腺癌と確認され, これらより右副腎腫瘍の左肺転移と考え, 右副腎腫瘍摘出術を行った.術後は7日目にWBC, CRPは低下し炎症反応の改善を認めた.病理組織からは肺癌の副腎転移が疑われ, 胸腔鏡下に肺腫瘍の摘出を試みたが, 肺動脈との癒着で剥離困難のため化学療法を行った.その後, 肺腫瘍の進行は認めなかったが, 右腎上部に2.5cm大の腫瘍再発を認め, 化学療法を行ったが腫瘍は9cm大となり死亡した

A 62-year-old man was admitted with chief complaints of fever and general fatigue. Enhanced computed tomography revealed a tumor (5 cm in diameter) in the right suprarenal space, and the right renoportal lymph nodes were swollen. An abdominal TI-weighted MR image showed a low-intensity tumor measuring 4.5 x 5.5 x 6.0 cm. Chest computed tomography revealed two tumors. One was 1.5 cm, on the hilum of left lung, the other was 1 cm in the S6 lung field near the pleura. These findings strongly indicated primary adrenal carcinoma and lung metastasis. Right adrenalectomy was performed. Histological examination of this tumor revealed diffuse tumor cells with irregular nuclei, and it was diagnosed as poorly differentiated adenocarcinoma. There was no possibility of primary adrenal carcinoma. The primary site of the tumor was suspected to be the left lung.