視力喪失が初発症状の腎原発全身性転移癌

Visual loss as the initial manifestation of renal cell carcinoma with systemic metastases

　57歳男性で，視力低下が初発症状の腎原発全身性転移癌の1症例を報告した。初診日の1週間前に突然左眼の視力喪失を訴えた。原発巣の症状は全くなかったが，既に全身の骨および脳に転移しており，腫瘍による視神経の直接圧迫による視力低下と考えた。以後，徐々に重篤な全身症状が出現し，患者の希望により放射線療法を行った。放射線療法施行後MRIで腫瘍は明らかに増大しており，放射線療法の効果はなかったが，ターミナルケアの場面では，患者のquality of lifeの向上を第一に，治療方法を選択することが重要であると考えられる。

A 57-year-old male presented with sudden visual loss in his left eye since one week before. His left visual acuity was light perception. Systemic studies showed renal cell carcinoma with metastases to the bones and the brain. The visual loss appeared to be due to compression of the optic nerve by the tumor. The patient elected radiation therapy which proved to be futile when examined later by magnetic resonance imaging. The present case illustrates the need to select due therapeutic modalities as terminal care with due consideration of the quality of life.