後腹膜悪性神経鞘腫の1例

Abstract

56歳女.無痛性の左上腹部腫瘤を自覚したが放置していた.腹部超音波断層法, 腹部CT検査により左腎腫瘍を疑い, 入院となった.画像所見などから左腎腫瘍の可能性は低く, 左腎近傍に発生した後腹膜腫瘍を疑い, 根治的腎摘出, 腫瘍摘出術を施行した.組織学的検査により, 後腹膜腔原発の悪性神経鞘腫と診断した.術後経過は良好で, 術後14日目でのNSEは正常範囲内であった.文献上, 放射線, 化学療法共に有効な治療法が見られないため厳重に経過観察することとし, 退院となった.術後外来にて定期的に造影CT検査, NSE値の観察を継続しているが明らかな再発, 転移の徴候なく, 1年経過した現在も無病生存中である

A 56-year-old woman was admitted with a complaint of a palpable left abdominal mass. The left kidney was compressed by the tumor which measured 18 x 10 cm in size on computed tomographic scanning. We diagnosed a left renal tumor or retroperitoneal tumor. No metastatic lesions were detected. We performed radical nephrectomy with complete tumor resection on August 28, 1997. The tumor had two satellites and was adherent to the renal capsule. A yellowish-white solid tumor was macroscopically encapsulated by fibrous tissue and had cystic lesions filled with bloody fluid, weighed 940 g and was 18 x 11 x 8 cm in size. Histopathological diagnosis was malignant schwannoma. No lymphnode metastases were observed. For poor responsiveness to chemotherapy and radiation therapy in this type of tumor, we did not perform adjuvant therapy. The patient is alive with no evidence of recurrence more than four years after surgery.