腎盂原発Sarcomatoid carcinomaの1例

Abstract

65歳男.左水腎症と診断され, 経過観察していたが, 腫瘤の増大を認め, 左上腹部の膨満感, 疼痛が出現したため, 加療目的に入院した.画像診断などから左尿管結石による左水腎症, 無機能腎と診断し, 全身麻酔下経腹的左腎摘除術を施行した.病理組織学的所見はsarcomatoid carcinoma of renal pelvis, G3, pT3, Nx, MOであった.術後補助療法としてmethotrexate, epirubicin, cisplatinumの3剤による化学療法を2コース施行したが, 術後2ヵ月の腹部CTで大動脈周囲リンパ節への再発を認めた.術後6ヵ月目に, 腹部リンパ節の腫大による閉塞性黄恒, イレウスをきたし再入院した.術後8ヵ月に肺炎を併発し死亡した.剖検で傍大動脈より左鼠径部迄の広範なリンパ節転移の他, 骨, 右副腎, 膵, 皮膚等に転移巣を認めた.転移巣の組織には移行上皮癌がspindle cellより優位に認められた

A 65-year-old man visited our hospital with the complaint of left hypochondrial pain. Since he had left giant hydronephrosis due to ureteral stone, we performed left nephrectomy. Unexpectedly, macroscopic examination of the resected kidney revealed multiple yellowish nodules located in the renal pelvis and calyces. Histopathologically the nodules consisted of two pattern of malignancy, transitional cell carcinoma and spindle sarcomatous tumor. Immunohistochemical examination showed that spindle cells were stained positive for cytokeratin, and the final diagnosis was sarcomatoid carcinoma of left renal pelvis. Postoperatively, the patient underwent two courses of adjuvant chemotherapy, but metastases to retroperitoneal lymph nodes were noted two months after operation. He died of the disease eight months postoperatively.