孤立性対側副腎転移を伴った腎細胞癌の1例

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症例は73歳女で,定期検診の腹部CTで右腎腫瘤を指摘され,当科紹介となった.腹部CT,腹部MRI,血管造影所見より,左副腎腫瘤は内分泌学的に非活性であり,画像上,右副腎には転移を認めず,右腎腫瘍及びその左副腎転移の診断のもと,右副腎温存根治的右腎摘除術及び左副腎腫瘍摘除術を施行した.摘出標本は径6cm大の腎腫瘍と4cm大の副腎腫瘍であった.病理組織所見は腎細胞癌,alveolar type,common type,clear cell subtype,G2≫G3,pT2であり,副腎腫瘍の所見も原発巣に一致していたA 73-year-old female visited our department with right incidentally-found renal tumor, which was revealed by follow-up computed tomography (CT) on an annual physical check-up. CT also showed a left adrenal mass that was 4 cm. Further evaluation suggested right renal cell carcinoma and left adrenal metastasis. The patient, therefore, underwent right-adrenal-gland-sparing radical nephrectomy and left adrenalectomy. The pathology report indicated renal cell carcinoma with contralateral adrenal metastasis. A case of contralateral adrenal metastasis from renal cell carcinoma is not common clinically. Furthermore, whether ipsilateral adrenalectomy should be performed in such a case is still controversial at this stage.