高カルシウム血症を合併した顆粒球コロニー刺激因子(G-CSF)産生腎盂腫瘍の1例

Abstract

73歳男.血尿と左側腹部痛を認め, 体重減少も認めたため受診し, 超音波断層検査で, 左腎上極に腫瘤を認めた.腹部CTで, 左腎の腫瘤は, 嚢胞変性を強く認め, 造影により不均一に増強された.腫瘤は腎実質方向への浸潤が強く, 一部は被膜をこえ, 膵への浸潤も疑われた.年齢, 全身状態, 腫瘍の進展を考慮し, 根治的手術は不可能と考え, 局所麻酔下に, 経皮的腫瘍生検を施行した.左腎盂原発の高カルシウム血症を伴った血中顆粒球コロニー刺激因子(G-CSF)産生移行上皮癌で, 治療開始3週後, 白血球, 血中カルシウムの再上昇とともに, 悪液質が進行し, 腫瘍からの出血によるショックをきたし死亡した

A 73-year-old man was admitted to the hospital complaining of gross hematuria and left flank pain. Abdominal ultrasonography and computed tomography revealed a left renal tumor with extracapsular extension. Laboratory data showed marked leukocytosis of 121, 000/mm3 and hypercalcemia of 12.3 mg/dl without any findings of inflammatory disease or bone metastasis. Enzyme immunoassay of the serum demonstrated a high level of granulocyte colony-stimulating factor (250 pg/ml) and parathyroid hormone-related protein (1, 069 pmol/l). Pathological diagnosis of needle biopsy specimen of the primary tumor was transitional cell carcinoma which was suspected to have originated from renal pelvis. Immunohistochemical examination with anti-granulocyte colony-stimulating factor monoclonal antibody demonstrated granulocyte colony-stimulating factor production in cancer cells. The patient underwent a course of systemic chemotherapy, but died two months after diagnosis. To our knowledge, this is the first report of renal pelvic cancer representing granulocyte colony-stimulating factor production and hypercalcemia simultaneously.