特発性血小板減少性紫斑病を合併した腎細胞癌の1例

Abstract

29歳女性.患者は特発性血小板減少性紫斑病(ITP)に対するプレドニゾロン(PSL)治療経過中のスクリーニングCTにて左腎腫瘍を指摘され, 著者らの施設へ紹介入院となった.精査の結果, ITPに合併した左腎癌と診断し, PSL内服を継続するとともにガンマグロブリン大量療法を5日間行ったところ, 血小板数の上昇を認め, 経腹的左腎摘出術, 脾摘出術を施行した.本症例はPSLの投与期間は8ヵ月とそれほど長期間ではなかったが, 術中組織・血管の脆弱化により, 出血しやすく, 血管も破綻しやすかった.そこで, 厳重な抗生剤点滴静注とヒスタミンH2受容体拮抗薬の投与と術中・術後のステロイドカバーを行った.病理組織学的に淡明細胞癌で, 術後経過良好であった

A 29-year-old woman was referred to another hospital with complaints of bruising and ecchymosis and thrombocytopenia (12, 000/microl) was pointed out. After some examinations, the patient was diagnosed with idiopathic thrombocytopenic purpura and was started on steroid therapy. Then the patient consulted our hospital and computerized tomography revealed a left renal tumor 4 cm in diameter. Under the diagnosis of left renal neoplasm we performed left nephrectomy and splenectomy with preoperative high-dose intravenous gammaglobulin treatment. Pathological examination revealed clear cell carcinoma. After the operation, the platelet count increased gradually. We should consider bleeding tendency by thrombocytopenia and side effect of long-term steroid treatment when we perform operations on patients with idiopathic thrombocytopenic purpura.