腎摘出後10年以上を経て脳転移した腎細胞癌の2例

Cerebral Metastasis from a Renal Cell Carcinoma more than 10 Years after Nephrectomy : report of two cases

I．はじめに

　腎細胞癌の脳転移は3.9-9.7％と報告されている^1,4,6）が，腎摘出後平均3年で診断されている．10年以上経て脳へ転移した症例は非常に稀である．われわれは腎摘出後12年，15年を経て脳転移した2症例を経験したので報告する．

The authors report two cases with renal cell carcinoma (RCC) metastatic to the brain more than 10years after nephrectomy. Case 1: An eighty-six-year-old female, on whom nephrectomy had been per-formed 12 years before, complained of alexia. Computed tomography (CT) revealed ring enhancement inthe left temporoparietal region. Total removal of the brain tumor and irradiation of 18Gy during surgerywas performed. Histological examination showed metastatic brain tumor from RCC. The postoperativecourse was excellent. In the postoperative examination lung metastasis was found. Case 2: A sixty-seven-year-old male, on whom nephrectomy had been performed 15 years before, presented with right hemi-paresis, aphasia and convulsion. CT showed two enhanced lesions, one of which accompanied with ahematoma in the left frontal lobe. Chest X-ray showed a coin lesion in the right lower lobe. Total removalof brain tumors was performed and 18 Gy irradiation was administered during surgery. Histological studyrevealed RCC. However, 3 months after surgery, a new lesion was recognized in the opposite hemisphere. The long interval of latency may be attributed to the slow-growing characteristic of renal cell carcinomaand the fact that renal cell carcinoma is under the influence of host immunity.

Surgical treatment is recommended for patients who develop a solitary metastatic lesion or in whomother lesions are controlled and remain in a stable condition.