Cyclophosphamideにより誘発されたと思われる腎盂腫瘍の1例

Abstract

症例は24歳男性で, 10歳時に左仙腸関節部横紋筋肉腫にて腫瘍摘出術を施行し, 残存腫瘍に対して27ヵ月に亘っての全身化学療法(Vincristine[VCR]/ActinomycinD[ACD]/Cyclophosphamide[CPM]/Doxorubicin[DXR])を受け寛解し, その後再発は認めていない.抗癌剤の総投与量はCMP 43.4g, VCR 21.6mg, ACD 16.9mg, DXR 486mgであった.2ヵ月ほど前から排尿時痛を認め, 近医にてクラミジア尿道炎の診断で投薬を受けたが軽快せず, 静脈性腎盂造影にて左腎盂に欠損像を認めたため精査加療目的で紹介来院した.左腎盂造影で陰影欠損像が認められ, 腎盂尿の細胞診はclass Iであった.腹部CT・MRI所見からCPM投与による二次性発癌の左腎盂腫瘍と考え, 左腎尿管全摘徐術を施行した.摘出腎の割面において腎盂より隆起する37×29mmの非乳頭状広基性腫瘍を認めた.術後補助化学療法は施行せず経過観察中であるが, 術後17ヵ月現在, 腫瘍の転移・再発は認めていない

We report a case of transitional cell carcinoma in the left renal pelvis, which occurred in a 24-year-old man. He had been treated with cyclophosphamide (CPM) for a period of 27 months for retroperitoneal rhabdomyosarcoma diagnosed at the age of 10. At first 1.2 g CPM had been given twice intravenously for 3 months, followed by oral administration of 41 g CPM for 23 months. Drip infusion pyelography revealed a filling defect in the left renal pelvis. A left renal pelvic tumor was strongly suspected on computerized tomography and magnetic resonance imaging. Left nephroureterectomy was then performed. Histological diagnosis of the left renal pelvic tumor was transitional cell carcinoma, grade 2, pT1N0M0. No recurrence was defected 17 months later. This case seems to be the second case of cyclophosphamide-induced upper urothelial carcinoma reported in Japan.