腎自然破裂を契機に発見されたAcquired cystic disease of the kidney(ACDK)に合併した腎細胞癌の1例

Abstract

67歳男.血液透析療法中に腎自然破裂を契機に発見された腎細胞癌の症例について報告した.右側腹部痛を主訴とし, 腹部CT検査にて右腎から後腹膜へ広がる出血を認めたため入院となった.生化学検査にて腎機能障害を認め, CRPは炎症反応の軽度亢進, IAPは軽度上昇が見られた.腹部単純CTにて両側腎に多発性嚢胞を認めた.長期血液透析による後天性嚢胞性腎疾患(ACDK)の自然破裂と診断し, 右腎摘出術を施行した.右後腹膜腔は血腫により緊満しており, 腎, 血腫および周囲組織は癒着していた.ACDKに合併した腎細胞癌の自然破裂と診断し, 術後2ヵ月で再発や転移は見られない

A 67-year-old male had been maintained on hemodialysis for 13 years because of chronic renal failure secondary to diabetes mellitus. The patient was referred to our hospital with sudden right flank pain. Computed tomography revealed multiple cysts in both kidneys and a right massive perirenal hematoma. Although there was no definite evidence of a renal tumor, a right nephretomy was performed. Histological study revealed acquired cystic disease of the kidney (ACDK) with a hematoma containing papillary renal cell carcinoma. He has been free of recurrence for 2 months. To our knowledge, this case is the fourth report of renal cell carcinoma in ACDK manifested by spontaneous rupture in the Japanese literature.