腹腔鏡下腎摘出術後にポート部再発した原発性腎盂腺癌の1例

Abstract

76歳女性.患者は食欲不振, 全身倦怠感, 上腹部圧迫感と発熱で近医を受診, 左季肋部に手拳大の腫瘤を指摘され紹介入院となった.腫瘍マーカーはCA19-9が高値で, 尿細胞診はclass IIであった.CTで高度の左水腎症を認め, 順行性・逆行性腎盂造影では左腎盂の著明な拡張を認めた.腎盂尿管移行部狭窄と診断し, 腹腔鏡下左腎摘出術を施行した.摘出標本割面には腎盂内に突出する多発性の乳頭状腫瘤を認め, 病理診断はpapillary adenocarcinoma of the renal pelvis, G3, pT1aであった.その後, 術後10ヵ月にMRIを行なったところ左腸腰筋部に局所再発を認め, 放射線療法を施行したが, その2ヵ月後には臍上部のトロカール部付近に腹壁再発を認め, 生検ではpapillary adenocarcinomaであった.患者は次第に全身状態は悪化し, 最終的に多発性転移で死亡となった

We report a case of port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy. A 76-year-old woman was admitted to our hospital with a complaint of anorexia, general malaise and left abdominal distension. Computed tomography revealed severe hydronephrosis in the left kidney. Laboratory examination revealed a high serum level of CA19-9 (155 U/ml). However, antegrade and retrograde pyelography revealed no filling defects and urine cytopathology for renal pelvis showed no malignancy. Thus, on the suspicion of a ureteropelvic junction stenosis, a laparoscopic nephrectomy was performed. There were some papillary tumors in the renal pelvis and a histopathological examination of the tumor revealed a papillary adenocarcinoma. Twelve months after nephrectomy, left iliopsoas muscle metastasis was found. Thus irradiation therapy with a total of 30 Gy was performed. However, 3 months later, the patient developed metastasis at the trocar site and the serum level of CA19-9 elevated to 6, 720 U/ml. She died of multiple metastases from adenocarcinoma of the renal pelvis 4 months after port site metastasis.