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

Abstract

16年間慢性血液透析を受けている41歳男で, 突然左腰背部痛を自覚した.来院時出血性ショック状態であるが, 保存療法により全身状態は改善した.CT上両側後天性嚢胞性腎疾患者及び左腎破裂が認められた.腎腫瘍の明確な証拠はないが, 1週後に根治的左腎摘除を行った.切除腎に5.5×5.0×4.5cmの黄色調腫瘍が認められた.病理学的に嚢胞型, 通常型, 淡明細胞亜型, pT2pN0M0の腎細胞癌であった.3ヵ月間, 再発, 転移は認められていない

We report a case of renal cell carcinoma in acquired cystic disease of the kidney (ACDK) presenting with a spontaneous renal rupture. A 41-year-old man on chronic hemodialysis for 16 years was referred to our hospital with sudden left back pain. On arrival, the patient was in a state of hemorrhagic shock but his general condition improved by conservative therapy. Computed tomography demonstrated a left renal rupture as well as bilateral ACDK. Although there was no definite evidence of a renal tumor, a left radical nephrectomy was performed one week later. The resected kidney contained a yellowish-brown tumor of 5.5 x 5.0 x 4.5 cm in size. Pathological examination revealed renal cell carcinoma, cystic type, clear cell subtype, pT2pN0M0. He has been free of recurrence for 3 months.