成人型Wilms' tumorの1例

Abstract

56歳女.CTで右腎腫瘍を指摘され精査目的で入院した.画像診断等により右腎上極に発生した悪性腎腫瘍の存在を強く疑い経腹的腎摘除術及び腫大したリンパ節を切除した.病理組織所見では核の退形成は認められずNational Wilms' Tumor Studyによる分類上stage III, favorable histologyの成人型Wilms' tumorと診断した.再発リスクを考慮し, 術後補助化学療法としてetoposide, cisplatin, ifosphamideにより3剤併用療法を2コース施行し, 6ヵ月経過した現在, 再発を認めず外来により経過観察中である

Wilms' tumor is very rarely found in adults and there are no established treatment guidelines for such tumors in adults. A 56-year-old woman was referred to our hospital for further examination of macroscopic hematuria. Computed tomography scan revealed a large right renal mass with enlarged lymph nodes. Angiography showed a hypovascular tumor. She underwent right nephrectomy and resection of lymph node metastasis with a diagnosis of malignant renal tumor. Histopathological examination revealed nephroblastoma with lymph node metastasis. The disease was classified as stage III according to the National Wilms' Tumor Study classification. The patient received adjuvant chemotherapy consisting of ifosfamide, cisplatin, and etoposide. This protocol was selected because of the published poor results with the standard Wilms' tumor chemotherapeutic agents when used in adults. She remained without tumor recurrence as of six months after surgery. Development of better therapeutic approaches to adult Wilms' tumor is awaited.