自然破裂をきたした腎平滑筋肉腫の1例

Abstract

右側腹部痛を主訴とした53歳女で, 超音波検査は右腎下極に充実性腫瘤病変を示し, 数日後, 突然増大した腹部腫瘤に痛みを感じた.CTは不均質な密度の巨大な後腹膜腫瘤を描出した.腎腫瘍を自然破裂が疑われ, 緊急腎摘出が行われた.破裂腫瘍は蒼白, 弾性硬で, 十二指腸に直接浸潤していた.組織学的に大部分の領域で中等度の核異型を示し, 高頻度の核分裂像が認められ, 免疫染色で腎平滑筋肉腫と診断された.術後2ヵ月に腸穿孔により死亡した

A 53-year-old female visited our out-patient department complaining of right flank pain. Ultrasonography revealed a solid mass lesion in the lower pole of the right kidney and further evaluation was scheduled. A few days later, she suddenly felt pain at the abdominal enlarged mass. Computed tomographic (CT) scan revealed a huge retroperitoneal mass with heterogenous density. Spontaneous rupture of renal tumor was suspected and emergency nephrectomy was performed. The ruptured tumor was pale, elastic firm and invaded directly to the duodenum. Histopathological findings revealed fibrous cells with frequent nuclear mitosis. Smooth muscle actin was identified immunohistochemically. Therefore, the tumor was diagnosed as leiomyosarcoma. The patient died 2 months after operation due to perforation of the intestine.