頚椎転移巣から偶然に発見された腎細胞癌

Abstract

A 41-year-old man developed rigid scalp which his barber first noted. He was seen with pain in the neck and shoulders, when bone x-ray showed destruction of the third cervical vertebra and osteolytic change of the twelfth dorsal vertebra. Bone scintigraphy revealed accumulation of 99mTc-EHDP in the above vertebrae and parietal bone. There was a defect of stain at the lateral aspect of the lower pole of the right kidney. The right kidney was then suggested as the site of original tumor. Angiography and pyelography confirmed this, and right nephrectomy was done following spondylodesis with partial laminectomy of the cervical spine. The patient never passed hematuria due to tumor of the kidney. Metastatic tumor of the cervical spine, however, progressively increased and the patient became paraplegic. For the purpose of relieving the pressure upon the cord, the tumor was approached anteriorly but could not be resected because of profuse hemorrhage from the tumor. The biopsy at this time showed same histological finding as the kidney, clear cell carcinoma. The patient died of respiratory distress due to spinal paralysis five months after nephrectomy. Autopsy added the finding of a metastasis to the spleen.