腎盂原発顆粒球コロニー刺激因子（GCSF）産生腫瘍

Renal pelvic carcinoma producing granulocyte colony-stimulating factor（gcsf）：a case report

70歳，男性。血尿で初診し，造影CT，DIPの結果，左腎盂腫瘍と診断した。左腎尿管全摘除術を施行し，病理検査所見は一部扁平上皮癌を伴う移行上皮癌G2＞＞G3, pT3, INFβ腎門部リンパ節転移陽性であった。術前より白血球上昇を認め，顆粒球コロニー刺激因子（GCSF）産生腫瘍の可能性が疑われた。免疫学的病理検査と血液検査所見より，GCSF産生腎盂腫瘍と診断した。その後全身化学療法（GC療法を2コース）を行ったが，腎門部リンパ節，左副腎と肺に転移巣を認め，術後より5か月後に死亡した。

A 70-year-old man presented with gross hemturia. Abdominal computed tomography（CT）and intravenous phyerography（IVP）showed a tumor in the left renal pelvis and lymphadenopathies. Left nephroureterectomy was performed. Histological examination revealed urothelial carcinoma＞＞squamous cell carcinoma,G2＞＞G3,pT3,n＋. Because he had persistent neutrophilic leukocytosis before and after the operation,GCSF producing tumor was suspected. He had a high GCSF level in the serum after the operation and the tumor was positive with anti-GCSF monoclonal antibody in the immunohistological examinations,leading to the diagnosis of GCSF producing tumor. Although we performed adjuvant chemotherapy（GC）,metastases appeared after 2 cycles of chemotherapy. He died five months after the operation.