腎細胞癌にみられる肝機能障害

Abstract

Liver function of the patients with renal cell carcinoma was investigated on 65 cases experienced during Jan. 1963 to March 1975. Liver function was estimated by serum alkaline phosphatase, GOT, GPT, gamma-GTP, bilirubin, prothrombin time and α2-globulin. Liver function was considered to be impaired whenever three of above parameters showed abnormal value. Six of 65 (9.2%) had impaired liver function. In none of them metastasis to the liver was found at the time of surgery. Hematuria was noted in three of six, pain in three, mass in five, pyrexia in five and varicocele in three. High percentage of varicocele may suggest that the cause of liver dysfunction might be tumor invasion from the renal vein to the van a cava or compression over the vena cava or hepatic circulation by tumor. Removed kidneys of six cases weighed 420 to 1000 g (average 690 g), being relatively larger than usual. Histologically, 5 was clear cell type, and one was mixed cell type. Biopsy study of the liver was made in two cases. One showed marked fatty degeneration, and another moderate fatty degeneration, hepatocellular necrosis and cellular infiltration. Three cases who are alive showed the return to the normal liver function after nephrectomy. Impaired liver function without liver metastasis should be paid urologist's attention for early diagnosis of renal cell carcinoma. Impaired liver function does not mean the contraindication of nephrectomy. Postoperative change of liver function may tell the prognosis well.