肉腫様腎細胞癌の1例

Abstract

症例:75歳男.肉眼的血尿が出現し近医受診.腹部CTにて右腎腫瘍の診断を受け手術目的で入院した.経胸腹式右腎摘除術を行ったところ副腎への浸潤も認め, 病理学的所見と併せて紡錘細胞癌と診断した.予後不良であることが予想されたが年齢と一般状態を考慮し術後補助療法は行わず外来にて経過観察とした.術後2ヵ月で下大静脈のリンパ節転移および肝転移を認め, 急速に病状が進行し死亡した

A 75-year-old male presented to our hospital with a complaint of macroscopic hematuria. Laboratory examinations in peripheral blood showed slight anemia and the increase of acute phase reactants (c-reactive protein, immunosuppressive acidic protein, alpha 2-globulin). Abdominal enhanced computerized tomography revealed a huge tumor with calcification at the upper pole of the right kidney. Magnetic resonance imaging (MRI) showed a low intensity mass at the upper portion of the right kidney on T2-weighted sequences. The right radical nephrectomy was performed and the histopathological diagnosis was sarcomatoid renal cell carcinoma because of positive immunohistochemical staining for vimentin and negative for cytokeratin. Because sarcomatoid type has a highly malignant behavior and poor prognosis among renal cell carcinomas, an adjuvant treatment which is effective in controlling the disease is awaited.