左精索静脈瘤を合併した若年性左腎癌の1例

Abstract

25歳男.左精索静脈瘤と診断され高位結紮術を行った.術後2ヵ月に肉眼的血尿を認め, 腹部超音波, 腹部CTを行ったところ左腎上極に腫瘤を認めた.左腎癌の診断で手術目的に入院した.血管造影では左腎上極から中極にかけて腫瘤があり, 同部位に腫瘍血管の新生を認め左腎癌と思われた.また, 早期からpoolingと思われる造影剤の溜まりを認め, 無水アルコールにて左腎動脈の塞栓を行った.根治的左腎摘出術を行い, 病理的所見では顆粒細胞癌であった.術後1ヵ月目より週3回のIFN-αの筋注を行っている

A 25-year-old man presented to our hospital with the chief complaint of left-sided painless scrotal swelling. Varicocele was diagnosed and high ligation was performed. Two months later, he noticed asymptomatic gross hematuria. Transabdominal ultrasonography and abdominal computed tomographic scanning showed a left renal tumor measuring more than 10 cm in diameter. Radical nephrectomy (thoraco-abdominal approach) was performed and pathological diagnosis was granular cell carcinoma (G2, pT2, INF alpha, pNX, pMX). He then received intramuscular injections of interferon-alpha 3 million units on three days per week. The frequency of renal cell carcinoma was reported to be about 1-3% for individuals in the 20s in the recent Japanese literature, and renal cell carcinoma in a young man with left varicocele is very rare.