腎盂癌原発の転移性脳腫瘍の1例

A Case of Brain Metastasis of Renal Pelvic Carcinoma

Ⅰ．はじめに

　腎盂癌は全尿路腫瘍に占める割合は約3％とされ，比較的稀な腫瘍であり予後も不良とされる⁴⁾．腎盂癌の転移はリンパ節や肺，肝，骨などに起こりやすく，脳転移は極めて稀である⁶⁾．腎盂癌の脳転移に関する報告はわれわれが渉猟した限り，3例しかなされていない^2,6,7)．われわれは腎盂癌の脳転移例を経験したので，文献的考察をふまえて報告する．

　A 68-year-old woman was referred to our urological department with the complaint of hematuria and right abdominal mass. Contrast-enhanced computed tomography (CT) revealed renal tumor and multiple lung metastases. Right nephroureterectomy was performed. Pathological examination was transitional cell carcinoma. After nephroureterectomy, combination chemotherapy consisting of methotrexate, doxorubicin and cisplatin was performed. Oral administration of tegafur was continued outside the hospital. Eight months after the nephroureterectomy, she suffered from left hemiconvulsion and was transferred to our hospital. Contrast-enhanced CT of the head revealed a heterogeneous enhancement tumor in the parietal lobe. Surgical resection was performed by right parietal craniotomy. Because the tumor was invasive in the superior sagittal sinus, subtotal removal of the tumor was performed. Pathological examination indicated transitional cell carcinoma the same feature as in the renal pelvis. After surgical resection, she was treated by gamma knife stereotactic radiosurgery. She returned to ordinary life, but 7 months later tumor recurrence took place. Repeated surgical resection and stereotactic radiosurgery was performed, but she died 44 months after the initial nephroureterectomy due to the relapse of brain metastasis. Brain metastasis of renal pelvic carcinoma is extremely rare, and we have found only three case reports. We describe the course of our patient, and review the three cases of brain metastasis of renal pelvic carcinoma that are in the literature.