腎自然破裂を来し心筋転移が死因となった腎細胞癌

Spontaneous rupture of renal cell carcinoma with sudden death due to myocardiac metastases : A case report

　81歳女性．左側腹部痛を主訴に前医受診し，CTで左腎腫瘤を指摘され紹介．約10cmの腎細胞癌，下大静脈近傍までの腎静脈浸潤，下行結腸浸潤，多発リンパ節・肺転移を認めた．経過中に腎細胞癌破裂を来し，動脈塞栓術（TAE）後，根治的腎摘除術を行った．その後CT，心エコーで心筋転移を指摘され，術後39日目に突然死に至った．破裂前の腎細胞癌の診断，悪性腫瘍心転移の生前診断はまれであり，文献的考察を加えて報告する．

Abstract

Cardiac metastasis in the absence of inferior vena cava (IVC) extension is extremely rare. We report a case of myocardiac metastasis from renal cell carcinoma (RCC) without IVC involvement. An 81-year-old female with left flank pain was referred to own clinic and CT revealed left huge renal mass with an extension to left renal vein, descending colon involvement, and multiple lymph node and lung metastases. The following day, she was brought to the emergency room in a state of shock with severe abdominal pain. CT showed spontaneous rupture of RCC. We performed transcatheter arterial embolization and left transabdominal nephrectomy with partial descending colectomy. After the operation CT and echocardiography revealed cardiac metastasis. Postoperative course was uneventful, however, she suddenly died 39 days after the operation. Autopsy revealed myocardiac metastases of RCC, and blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest (Rinsho Hinyokika 73 : 320-323, 2019).