殿筋転移を認めた腎盂癌の1例

Abstract

57歳男性。患者は右背部痛を主訴に, 浸潤性右腎盂癌の診断にて右腎尿管全摘除術, MECによる化学療法を施行したところ, 術後6ヵ月目に肺, 右副腎に再発を認めた。そのためgemcitabine, paclitaxelによる化学療法を施行したが, 右中臀筋転移を認め, 右中臀筋転移巣の局所切除, TINによる化学療法が施行されたが, 再度, 右臀筋内に新規転移巣の出現を認めた。そこで, 同部位に放射線照射が行われたものの, 患者は最終的に心肺停止にて死亡となった。尚, 剖検は行われず, 放射線治療効果の判定や他の微小転移の有無については検証されなかった。

We present a case of gluteal muscular metastasis from a renal pelvic tumor. A 57-year-old man had undergone right nephroureterectomy and received 2 courses of adjuvant chemotherapy (MEC: methotrexate, epirubicin, cisplatin) for invasive renal pelvic tumor. Five months after the operation, computed tomography (CT) revealed pulmonary metastasis and right adrenal gland recurrence. He underwent 2 courses of chemotherapy (gemcitabine, paclitaxel). Postchemotherapy-CT scan showed a 2.2 cm mass in the right gluteal muscle. Since the size of the pulmonary metastasis and right adrenal gland recurrence showed no change, the gluteal mass was excised. Pathological diagnosis was metastatic urothelial carcinoma. Adjuvant chemotherapy (TIN: paclitaxel, ifosfamide, nedaplatin) 3 courses were performed, but postchemotherapy-CT scan showed a new 2.4 cm mass in the right gluteal muscle. He received radiation therapy (total 30 Gy) for the new gluteal mass. The common metastatic sites of renal pelvic tumor are lungs, liver, bone, and lymph nodes. Gluteal muscle is an uncommon site of metastasis of urothelial carcinoma. This is the 1st case of gluteal muscle metastasis from renal pelvic tumor in the literature.