CEA,CA19-9産生腺癌を伴った腎盂移行上皮癌の1例

Abstract

86歳男.肉眼的血尿を主訴とし, 右上部尿路腫瘍が疑われ精査予定であったが, 右腰背部痛, 発熱が出現し, 緊急入院となった.血液生化学検査ではCEAおよびCA19-9の高値を認め, RPにて右上腎杯に欠損像を認め, 右腎盂から採取したカテーテル尿細胞診はclass Vであった.右腎盂腫瘍と診断し, 右腎尿管全摘除術を施行した.病理組織学的所見, 抗CEAモノクローナル抗体および抗CA19-9モノクローナル抗体を用いた免疫染色所見より, 移行上皮癌G2>G3および腺癌, pT4と診断した.術後38日目にCEAおよびCA19-9は基準値以下となったが, 術後約4ヵ月にいずれも上昇を認め, 術後約6ヵ月のCTで肺および肝に転移を認めた.高齢かつ全身状態不良のため現在は経過観察中である

We report a case of invasive renal pelvic tumor with high serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9). An 86-year-old man presented with macrohematuria. Retrograde pyelography demonstrated a filling defect in right upper calyx, suspected of renal pelvic tumor. The levels of serum CEA and CA 19-9 were elevated to 28.0 ng/ml and 122 U/ml, respectively. No abnormalities were found in the gastrointestinal tract. Right nephroureterectomy was performed, and histopathological diagnosis was transitional cell carcinoma, grade 2>grade 3, accompanied with adenocarcinoma immuno-stained for CEA and CA19-9. A part of the tumor showed a tubular growth pattern. Both serum levels of CEA and CA 19-9 immediately decreased to the normal range after the operation, but increased again with lung and hepatic metastases.