アスベスト曝露歴を有した悪性胸膜中皮腫, 腎細胞癌の同時発生の1例

Abstract

66歳男性。患者は咳および咽頭痛を主訴に, 胸部レントゲンにて異常陰影を指摘され, 著者らの施設へ紹介となった。職業歴としてアスベストを使用する職場の勤務歴があった。胸腹部CTでは右胸腔の多発性結節および左腎腫瘍が認められ, まず, 腎腫瘍に対し根治的左腎摘除術を施行し, 病理組織学的に腎細胞癌の診断を得た。次に胸腔鏡下胸膜生検術を行い, 病理組織所見およびアスベスト被曝歴を考慮し, 悪性胸膜中皮腫T1bと診断された。今後, 治療としては右胸膜肺全摘除術, 化学療法, 放射線療法が検討されている。

A 66-year-old man visited complaining of cough and sore throat. He had been exposed to asbestos 43 years ago. Chest X-ray revealed left pleural effusion and abnormal shadow in the right lung field. Chest computed tomography (CT) showed multiple enhanced nodules in the right pleural cavity. Abdominal CT showed a 3-cm enhanced tumor in the lower pole of the left kidney. Left radical nephrectomy was performed. Pathological diagnosis was renal cell carcinoma. Postoperatively pleural biopsy was performed by using thoracoscopy. White plaque was seen at the costal pleura and surface of lung. Pathological diagnosis was malignant pleural mesothelioma based on using mesothelium-associated antibodies: calretinin (+), CK5/6 (+), D2-40 (+), HBME-1 (+), TTF-1 (-), MOC31 (-), CEA (-). Combination therapy (extrapleural pneumonectomy, chemotherapy, and radiotherapy) was initiated. Malignant mesothelioma is a devastating neoplasm with a strong etiological relationship with asbestos exposure. The incidence is rising in industrialized countries, with the peak expected in the year 2020. However, renal cell carcinoma with malignant pleural mesothelioma is very rare and this is the 2nd case in the Japanese literature.