両側副腎転移をきたした腎細胞癌の1例

Abstract

57歳男。左腎腫瘤の精査を主訴とした。造影CT早期層にて左腎上極に内部が不均一に濃染される腫瘍と両側副腎の腫瘍を認めたが, 左腎腫瘍と左副腎腫瘍は画像上連続性を認めなかった。リンパ節や他の臓器転移, 下大静脈腫瘍塞栓, 下垂体腫瘍も認めず, 左腎細胞癌の診断で左腎摘除術および両側副腎摘除術を施行した。左腎腫瘍は病理組織学的にclear cellが胞巣状あるいは充実性に増殖し, 左右副腎腫瘍も組織学的に左腎腫瘍と同様であり転移と考えられた。術中よりヒドロコルチゾン補充療法を行い, 8ヵ月経過現在再発は認めていない。

We report a case of renal cell carcinoma with bilateral adrenal metastases. A 57-year-old man was admitted to our hospital for a left renal mass. Computerized tomography and magnetic resonance imaging revealed a 4.5 cm left renal tumor and bilateral adrenal masses (3.0 cm on the right side and 2.0 cm on the left). A left nephrectomy and bilateral adrenalectomies were performed. The pathological findings showed clear cell carcinoma, G2 of left kidney metastasizing to both adrenal glands. The patient was administered supplementary hydrocortisone and was well 8 months after the nephrectomy and adrenalectomies without evidence of recurrence. Bilateral adrenal metastases from renal cell carcinoma are relatively rare. Our case seems to be the thirteenth case in the Japanese literature.