腎癌小腸転移の1例

Abstract

57歳女性.患者は約2年前に右腎腫瘍で右腎部分切除術, 翌年には多発性肺転移で免疫療法を, 更に脳転移で開頭術と3回のラジオサージャリー, および第5腰椎への骨転移に対して放射線治療を施行していた.今回, 悪心嘔吐, 腹痛で入院するも保存的治療では軽快せず, 黒色便の出現や貧血の進行もあらわれた.所見では, CTで拡張した腸管内によく造影される不整形の腫瘤が認められたが, 上・下部消化管内視鏡ならびに注腸造影では異常を認められなかった.癌性腹膜炎または小腸腫瘍の診断で開腹手術を行ったところ, 回腸末端より2m口側の腸管腔内に腫瘤を認め, これを切除し端々吻合を行った.摘出標本では, 腫瘤は10×5cm大の内腔へ突出する有茎性腫瘤で, 割面は暗赤色充実性であった.病理組織所見ではMetastatic clear cell carcinoma, G3>G4, INFβで, 腎癌の小腸転移と診断された.術後, 経過は良好であったが, 脳転移の悪化で術後より102日目に死亡となった

We report a case of small intestinal metastasis from renal cell carcinoma (RCC) in a 57-year-old female. The patient had undergone partial nephrectomy for a right RCC (pTlaN0M0) in June 1997. She later developed multiple metastases, in the lungs, brain, and bone, and was admitted with nausea, vomiting, and appetite loss in April 2003. She presented with melaena a few weeks after her admission and a computed tomographic scan revealed a small bowel mass that was not definitively diagnosed. We removed the mass surgically, and the histological features confirmed the diagnosis as metastatic RCC. The patient recovered and could consume, but died of brain metastases 102 days after the surgery. Metastasis of RCC in the small bowel is a rare entity clinically. To our knowledge, this is only the 20th case of small intestinal metastasis from RCC reported in the Japanese and English literature.