腎洞部病変から明らかとなった全身多発型Castleman病の1例

Abstract

症例は79歳男性で, 頸部, 鎖骨上窩, 眼窩のリンパ節炎の既往がありリンパ節病変の摘出を受けていた.今回食欲不振と体重減少を主訴とし, CRP上昇, 赤沈値高進, 高ガンマグロブリン血症などを認めた.腹部CT及びMRIから腎盂腫瘍或いは腎実質性腫瘍を疑った.術中所見からリンパ節転移を伴う腎盂癌或いは腎実質性腫瘍と診断し, 腫大リンパ節を切除し左腎を摘除した.病理組織学的所見から本病のplasma cell typeと診断し, 以前の摘出標本も同様であった.術後もガンマグロブリンやIL-6の高値を認めるが, 術後12ヵ月の現在画像上明らかな病変は認めない

A 79-year-old man complained of anorexia and weight loss. Computed tomography and magnetic resonance imaging showed a solitary mass in the left renal sinus. Left nephrectomy was carried out under a clinical diagnosis of renal pelvic tumor. The pathological diagnosis was plasma cell type of Castleman's disease. The patient suffered from lymph node swelling in the right neck at age 75 and the lymph node was resected. The pathological diagnosis was lymphadenitis but it proved to be plasma cell type of Castleman's disease. The patient also had had a lymphadenectomy in the supraclavicular fossa and in the supraorbital area at age 76. Both had been diagnosed as lymphadenitis pathologically but they proved to be plasma cell type of Castleman's disease. The final diagnosis was multicentric Castleman's disease. We reviewed multicentric Castleman's disease.