CEA産生腎盂尿管癌の1例

Abstract

62歳男.右側腹部痛を主訴とし, 腫瘍マーカーCEA, CA19-9が高値を示した.超音波検査では右腎が著明な水腎を示した.経皮的腎瘻術を施行し, CTにて骨盤内尿管に腫瘤性病変を認め, さらに周囲への浸潤が疑われた.胸部X線検査, 骨シンチグラムで明らかな転移巣を認めず, 原発性腎盂尿管癌T3N0M0の診断で, 腎尿管全摘, 膀胱部分切除術を施行した.腎は水腎を呈し, 腎盂から腎実質内へ腫瘍浸潤が見られた.術後, 腎盂癌の多発性肺転移と診断され, 化学療法を施行したが死亡した

We report a case of carcinoembryonic antigen (CEA)-producing renal pelvic and ureteral cancer. A 62-year-old man consulted a local hospital with the chief complaint of right flank pain. On ultrasonography and CT scan, right hydronephrosis with the renal pelvis and ureteral tumor were detected, and he was referred to our hospital. Both serum levels of CEA and CA19-9 were elevated to 36.9 ng/ml and 119 u/ml, respectively. Close examination of the gastro-intestinal tract did not detect any sign of digestive tumor. Right nephro-ureterectomy was performed, and the tumor was histologically diagnosed as TCC G2 > G3 pT3, and CEA was positive in the tumor cells immunohistochemically. CA19-9 was also positive both in the tumor cells and normal epithelium of the renal tubules. Postoperatively, multiple lung metastases developed despite chemotherapy and the patient died 4 months after surgery. CA19-9 had immediately decreased to the normal range after preoperative percutaneous nephrostomy. CEA had transiently decreased postoperatively, but then increased with lung metastases, apparently related to the state of cancer.