副腎皮質ホルモン投与下に転移の完全退縮を認めた腎細胞癌の1例

Abstract

72歳男.腎細胞癌転移の退縮に副腎皮質ホルモンの関与が示唆された症例について報告した.血痰を主訴とし, 胸腹部CT検査にて右腎癌多発肺転移と診断された.胸部X線により両肺野に多発する腫瘤影を認め, 胸腹部CTにて両肺野に転移を約30個認めた.腹部CTにて右腎中極に腎実質より造影効果の乏しい境界明瞭な腫瘍を認めた.骨シンチでは右上腕骨に集積を認め, 右腎癌, 肺・骨転移T1aN0M1と診断し, 経腰的右腎摘出術を施行した.その後, 呼吸困難と低酸素血症を認め, 腎癌肺転移の急性増悪および癌性リンパ管症と診断した.胸部CTにて肺転移は退縮し, 骨転移も消失したため完全退縮と考えられた

A 72-year-old man presented with hemosputum and was admitted to our hospital. Computed tomography and osseous scintigraphy revealed right renal cancer and multiple pulmonary and osseous metastases. A translumbar nephrectomy was performed. The histopathological examination demonstrated granular cell carcinoma and clear cell carcinoma. The patient complained of dyspnea on postoperative day (POD) 16, and chest X-ray showed progression of the multiple pulmonary metastases and lymphangitis carcinomatosa. Betamethasone was administered for palliative treatment. After the treatment, dyspnea improved and chest X-ray on POD 57 showed disappearance of the multiple pulmonary metastases and improvement of lymphangitis carcinomatosa. Computed tomography and osseous scintigraphy confirmed complete regression of metastases. He has been free from recurrence for 16 months after the nephrectomy and for 13 months after the complete regression. To our knowledge, this is the first case of complete regression of metastatic renal cell carcinoma following corticosteroid treatment reported in Japan, and the second case when foreign literature is included.