腎細胞癌術後13年目に発見された膵・十二指腸転移の1例

Abstract

52歳男。39歳時に右腎腫瘍にて根治的右腎摘除術を施行され、術後は特に再発・転移の徴候はなかった。今回、起立性眩暈(立ちくらみ)、全身倦怠感を自覚し、貧血、体重減少、便潜血陽性で、上部消化管内視鏡検査を行い十二指腸に腫瘍性病変を認めた。同部位の生検にて低分化腺癌と診断された。画像検査で膵鉤部に腫瘤を認め、CTでheypervascularityを呈していた。十二指腸下行脚から水平脚にかけて浸潤を伴い、上膵十二指腸静脈から門脈本幹にかけて腫瘍塞栓を認めた。また、膵体尾部にも腫瘤を認めた。病理所見より腎細胞癌の膵・十二指腸再発転移と診断し、免疫療法としてIFN投与を予定した。しかし、食欲低下や嘔気が出現し、絶食、輸液管理とした。胃内ガス貯留が著明となり、機械的イレウスのため姑息的に胃空腸吻合術を施行した。術後天然型IFNα投与を開始したが、反復する消化管出血により貧血が進行し適宜輸血を行った。全身状態が悪化したためIFN投与は中止し、悪液質の進行にて癌死した。

A 52-year-old male was admitted to our hospital complaining of orthostatic vertigo, fatigue and weight loss, who underwent right total nephrectomy for renal cell carcinoma(RCC) with curative operation 13 years ago (in 1992). Endoscopic examination revealed a submucosal tumor with erosion in the duodenum. The diagnosis made from the biopsy specimens was metastatic RCC in the duodenum. Abdominal CT scan revealed that his metastasis has spread to the pancreas. Five million units of interferon a was administered intramuscularly three times a week for 1 month. He received blood transfusions and palliative care. He died 5 months later because of disease progression. Metastases of RCC have been often reported in the lungs, the liver, and the bones, but rarely in the gastrointestinal tract. This is a very rare case of metastatic RCC in the duodenum, which was diagnosed 13 years after curative right nephrectomy. Since late recurrence is characteristic of renal cell carcinoma, careful long-term follow-up is needed. To our knowledge, this is the 19th case of duodenal metastasis from RCC reported in the literature.