多包性副腎エキノコックス症の1例  [in Japanese] ADRENAL MULTILOCULAR ECHINOCOCCOSIS : A CASE REPORT  [in Japanese]

症例は79歳男性.感冒,体重減少を主訴に近医受診し,腹部CTにて右副腎腫瘍を認め,精査目的に当科入院.腹部CT上,内部不均一な腫瘤を呈し,血中,尿中ホルモン検査は正常値で, MIBGシンチ上uptakeなし. ^<131>Tアドステロール副腎シンチでは右副腎に集積低下を認めた.内分泌非活性副腎癌も考慮し右副腎腫瘍摘出術を施行した.摘出物は肉眼的に蜂窩状を呈しており,組織学的には内部に少数の原頭節と虫卵を認めた. ELISA, Western Blot法にて血清学的にエキノコックス陽性が確認され,多包性エキノコックス症と診断された.肝,脳,肺等,他に病巣は認めなかった.エキノコックス症には,単包性,多包性が存在し,ヨーロッパ諸国,地中海沿岸はおもに単包性が多く,日本では多包性が多く生息する.多包性エキノコックス症は約98%が肝原発であり,稀に脳,肺,骨にも感染するが,副腎発生での症例報告は本邦においてはない.またヨーロッパにおいては単包性での副腎発生の症例報告はあるが,頻度は0.05%と低い.多包性副腎エキノコックス症の報告は調べ得た範囲で世界に報告がなく,第1例目と考えられる.泌尿器科領域ではまれな寄生虫感染症も北海道居住歴の患者では,副腎腫瘍の鑑別診断として念頭にいれる必要があると思われた.

A 79-year-old man was consulted to our hospital for further examination of right adrenal tumor shown by computed tomography. Complete blood cell count, biochemical tests, hormonal examinations and urinalysis were normal. ^<131>I-adosterol scintigram showed decreased uptake on the right adrenal. Right adrenalectomy was done in consider to adrenal cancer. By the pathological findings and the serological tests (ELISA, and Western Blot examination), the tumor was diagnosed as an adrenal multilocular echinococcosis. Mainly, Echinococcosis caused by echinococcus granulosus and echinococcus multilocularis. While E. granulosus is endemic in Europe and Mediterranean coast etc., E. multilocularis is endemic in Japan and North America etc. In E. multilocularis, about 98% of the primary cyst are localized in the liver and the cyst are localized in the lung and brain etc, are rare. In Europe, the primary hydatid cyst is found in the adrenal in only 0.05% of the total case. Moreover, adrenal multilocular echinococcosis is extremely rare case, and is not presented yet in the world. By the patient's residential history, echinococcosis shoud be considered to differential diagnosis of the adrenal tumor in urology.