下大静脈腫瘍塞栓を伴った両側腎癌の1例

Abstract

71歳男。患者は全身倦怠感, 上腹部不快感, 食思不振を主訴とした。腹部造影CTで両側腎に腫瘍性病変が認められ, 更に下大静脈, 左腎静脈に腫瘍塞栓がみられた。両側腎癌, 下大静脈腫瘍塞栓と診断され, まず人工心肺併用で根治的右腎摘除術, 下大静脈腫瘍塞栓摘出術が施行された。そして約40日後, 根治的左腎摘除術を施行し, 2日後から血液透析を導入した。右副腎は温存したが, 左副腎は合併切除した。その結果, 術後は特に問題なく経過し, Adjuvant therapyは施行せず, 外来で経過観察となった。しかし, 術後9ヵ月経過で多発性骨転移, 多発性肝転移, 多発性肺転移を認め, 現在は対症療法中である。

We describe a case of bilateral renal cell carcinoma with the tumor thrombus in the inferior vena cava. A 71-year-old male was admitted to our department for, careful examination of bilateral renal tumors. Abdominal computed tomography (CT) revealed bilateral solid enhanced renal masses with the tumor thrombus in the inferior vena cava (IVC) and the left renal vein. The renal tumor did not reveal distant metastatic lesions. We enforced two-term operation for bilateral renal tumor. First, right nephrectomy and tumor thrombectomy in the IVC were performed. On the 32th day after the first operation, we performed left nephrectomy. On the second day after the last operation, the patient received hemodialysis. The histopathological diagnosis revealed bilateral renal cell carcinomas. At 9 months after the last operation, the patient had multiple bone metastases, multiple liver metastases and multiple lung metastases.