赤血球増多症を唯一の臨床症状とし,無症状に経過した巨大副腎皮質癌の1例

Abstract

A case of nonfunctioning adrenocortical carcinoma was found in a 29-year-old man. Physical examination was unremarkable except for an elastic hard mass, palpable five fingerbreadths beneath the right costal margin. In laboratory data, red blood count showed well remarkable increase and LDH exceeded normal range, but other laboratory data including urinary excretion of 17-KS and 17-OHCS were within normal range, IVP, abdominal aortography and retroperitoneal pneumography revealed that a large mass was located in the retroperitoneal space, displacing the right kidney downward. The diagnosis of retroperitoneal tumor was established, an extirpation was performed by thoracoabdominal route. A large tumor was found in which the kidney was encased and it had hard adhesion with the surrounding tissues, especially with peritoneum. It was removed with the kidney as a single mass. The removed tumor measured 25×15×7 cm, weighed 1, 400 g and it was encapsulated with thick fibrous membrane. On cut section the specimen was grayish yellow with scattered necrotic and hemorrhagic region. The histological examination revealed carcinoma of adrenal cortex. Statistical studies were done on 42 cases collected from the Japanese literature. The problems of the relation between polycythemia and erythropoietin-secreting tumor were discussed.