広範に壊死化した腎細胞癌の1例

RENAL CELL CARCINOMA WITH EXTENSIVE TUMOR NECROSIS: A CASE REPORT

　症例は66歳男性。左下腹部痛で発症，急性腹症として開腹され，生検により腎筋膜内に出血のみられる左腎腫瘍と診断された。手術後のCTでは左腎に腫瘍がみられ，血管造影では腫瘍に血管増生はなかつた。全身状態が良好なため11カ月後に再手術を行つた。腫瘍は腎筋膜内にとどまり，内部には泥状の壊死物質が充満し一部に血腫がみられた。本例では腫瘍内出血が突然起こり，この血腫により腫瘍が急激に圧迫壊死に陥つたと考えられた。

A 66-year-old man underwent an exploratory laparotomy because of severe pain in the left lower abdomen. A renal mass with perirenal hematoma was found and biopsied. The mass was necrotic renal cell carcinoma histologically. Elevated serum GOT, CPK, LDH returned to normal within two weeks. CT scan demonstrated a round mass in the left kidney. The mass was not hypervascular on renal angiography. Eleven months later the patient underwent successful radical nephrectomy. The mass was encapsulated and filled with a muddy substance and hematoma. Histologically the muddy substance was necrotic renal cell carcinoma.