副腎皮質癌の1例

Abstract

23歳男.発熱, 全身倦怠感で左副腎腫瘍を指摘された.腹部造影CTで腫瘍は不均一に造影され, 10×8cmで内部にリング状の石灰化を伴っていた.MRIのT2強調像では, 腫瘤は左腎と一体化していた.手術所見で, 腫瘍は横隔膜・腹膜と腸腰筋に強固に癒着していたが, 腎と一塊にしてen blocに摘出した.病理組織所見で, 好酸性の幅広い胞体と, 異型性や多形性の強い核から成る腫瘍細胞が充実性や索状の増生を示していた.細胞分裂像は1視野7個未満であった.術後弛緩熱は速やかに治まり, CRPも陰性化した.病理組織像より比較的予後良好と判断し, 術後補助療法は行わなかった.術後3ヵ月に腹部CTで腫瘤の再発を認め, 再手術を勧めたが拒否された.4ヵ月後には弛緩熱, 全身倦怠感が再発し, 12.9×11.8cmに増大した.外科的摘除は困難と判断し, 縮小を期待してo, p'-DDD, VP-16, ADM, CDDPのEDP+mitotane療法を2コース施行した.しかし腫瘍は増大を続け, 術後8ヵ月目に癌死した

We report a case of left adrenocortical carcinoma in a 23-year-old man. His chief complaints were spike fever attack and general malaise. Imaging examination revealed a heterogeneously enhanced mass at the site of the left adrenal gland. Non-functional adrenocortical carcinoma was suspected from hormonal studies. The mass was removed together with the left kidney because of severe adhesion to the renal pedicle. The histopathological findings showed adrenocortical carcinoma (pT3N0M0). Three months after surgery, local recurrence appeared and the tumor grew larger rapidly. Spike fever attack reappeared. No distant metastasis was detected. Two courses of systemic chemotherapy with o, p'-DDD, VP-16, adriamycin and cisplatinum were performed. Computed tomography after the chemotherapy showed progression. Although o, p'-DDD was administered continuously, the patient died of cancerous cachexia 8 months after the surgery. Autopsy could not be done.