下大静脈腫瘍塞栓をきたした前立腺癌

A case of prostate cancer with neoplastic thrombus in an inferior vena caval

76歳，男性。前立腺癌に対して内分泌療法併用放射線療法を施行されていたが，下肢の疼痛と腫脹を主訴に受診した。CTで下大静脈内に血栓を認めて深部静脈血栓症が疑われ，下大静脈フィルターの留置および抗凝固療法が開始された。一時的に血栓は縮小したが，3か月後のCTで血栓は増大した。MRIで再評価したところ，腫瘍塞栓の診断となった。その後，PSAの上昇とともに腫瘍塞栓は急激に増大し，数か月後に死亡した。

A 76-yesr-old man, who received MAB therapy for prostate cancer, stage C, visited our hospital complaining of lower extremity edema and pain. CT scan revealed inferior vena cava thrombus. Diagnosis of deep vein thrombosis was made and an inferior vena cava filter was placed to prevent pulmonary embolism and anticoagulation with warfarin was started. Once thrombus was reducted, but follow-up CT taken 3 month later revealed the increase of thrombus although he continued to take anticoagulation therapy. The thrombus was considered neoplastic because it was enhanced on the dynamic MRI images. The neoplastic thrombus rapidly increased in size with further elevation of PSA level and he died a few months later.