自然破裂をきたした腎血管筋脂肪腫と鑑別が困難であった腎細胞癌の1例

Abstract

56歳女.自然破裂をきたした腎血管筋脂肪腫(AML)との鑑別が困難であった腎細胞癌(RCC)の症例について報告した.右側腹部痛を主訴とし, 造影CTにて腎上極に巨大な腫瘤が認められた.胸部には血胸を認め, 血腫内に脂肪成分と思われる部位を認めAMLの自然破裂を疑った.出血部位を無水エタノールによって塞栓した.4ヵ月後の造影CTにて血腫は縮小したが, RCCが疑われたため経腹的根治的腎摘出術を施行した.病理では腎細胞癌, pTlb, 淡明細胞型G2であった

A 56-year-old woman was admitted with right flank pain as the chief complaint without any trauma. Abdominal and chest computed tomography (CT scan) demonstrated with low-density area in a retroperitoneal hematoma suspected of spontaneous rupture of angiomyolipoma and hematothorax. Superselective transarterial embolization and drainage of the thoracic cavity were performed. Three months later a right renal tumor in perirenal hematoma was revealed by abdominal CT scan and suspected renal cell carcinoma. Right nephrectomy was performed. Histopathology revealed renal cell carcinoma. Including this case, 31 cases of spontaneous rupture of renal cell carcinoma have been reported in the Japanese literature.