高カルシウム血症による精神症状を呈したPTH-rP産生肉腫様腎癌

A CASE OF PTH-rP PRODUCING SARCOMATOID RENAL CANCER PRESENTING PSYCHIATRIC SYMPTOMS DUE TO HYPERCALCEMIA

　1年前からせん妄状態が時折出現するようになり，抗精神薬の投与を受けていた80歳男性が，口渇，全身倦怠感を来し入院した。高カルシウム血症と副甲状腺ホルモン関連蛋白（PTH-rP）の高値を認め，精査したところ左腎腫瘍を認めた。左腎摘出術後，血清カルシウムおよび副甲状腺ホルモン関連蛋白は正常化し，かつ精神症状も消失した。摘出腎の病理診断は肉腫様腎癌であった。術後短期間に再発し，癌死した。

A 80-year-old man who had been suffering from psychi-atric symptoms such as dementia and delirium for one year was admitted complaining of thirsty and general fatigue. Laboratory data showed hypercalcemia and elevation of parathyroid hormone-related protein (PTH-rP). CT scan disclosed a large left renal tumor with abundant feeding vessels. Soon after left nephrectomy the serum calcium level and PTH-rP became normal and the psychiatric symptoms disappeared. Pathological diagnosis was sarcomatoid renal cancer. The patient died of recurrent cancer five months after surgery.