腎細胞癌の原発巣と遠隔転移巣の組織学的悪性度に関する検討

Abstract

原発巣に加えて遠隔転移を手術した46例について, 原発巣と遠隔転移巣のgradeの変化に関して, 各臓器別に検討した. 1)原発巣の各grade別に転移巣のgrade分布を比較した結果, grade Iを除けば約40%以上の例に原発巣と転移巣のgradeの不一致を認めた. 2)各転移臓器別に転移巣のgrade分布を検討した結果, 肺転移ではlow gradeの占める比率が84.6%で, 同様の傾向が膵転移(85.7%), 患側副腎転移(71.4%), 肝転移(100%), 脳転移(66.7%)等で認められ, 逆に骨転移ではhigh gradeの比率が87.5%を占め, 同様の傾向が対側副腎転移(100%), 膀胱転移(100%)で認められた

We studied the pathological features of renal cell carcinoma focusing on the changes of grade in the primary and metastatic lesions. The subjects consisted of 46 patients who received both nephrectomy and excision of distant metastatic lesions. As to the grade of metastatic lesions assessed according to the grade of primary lesion, over 40% of metastatic lesions did not coincide with the primary lesion except for grade I. In the study on the grade in each metastatic organ, as to lung metastasis, the rate of low grade malignancy (grades I and II) was 84.6%, and the same tendency was observed in the spleen (85.7%), adrenal gland of the affected side (71.4%), liver (100%) and brain (66.7%). On the other hand, as to the osseous metastasis, the rate of high grade malignancy (grades III and IV) was 87.5%, and the same tendency was observed in the contralateral adrenal gland (100%) and bladder (100%). We conclude that a lower grade clones as well as higher grade clones in the primary lesion must be analyzed to elucidate the metastasis of renal cell carcinoma.