褐色細胞腫肝転移の1例 [in Japanese] A CASE OF PHEOCHROMOCYTOMA WITH HEPATIC METASTASIS [in Japanese]
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褐色細胞腫の約10%が悪性といわれているが,再発例に対して外科的切除ができることは少ない.今回,原発巣切除後も血中ノルアドレナリン値が高値を示し,厳重に経過観察をした結果,発見できた肝転移を切除できたので報告する.<br> 症例は70歳,男性. 65歳時に腰痛を主訴に来院精査の結果,左副腎褐色細胞腫の診断で左腎膵体尾部脾を含めて合併切除施行.術後,高血圧と血中ノルアドレナリン値の高値が続き検索を繰り返したが再発を発見できなかった. 5年後の70歳時に初めて肝腫瘤を認めた.弧発性であったため肝切除を施行.術後病理検査にて褐色細胞腫の肝転移と診断した.術後血中ノルアドレナリン値は正常化し血圧も正常化した.
It is said that approximately 10% of pheochromocvtomas are malignant, but surgical resection for recurrent disease can be performed in few cases. We report patient with pheochromocytoma who maintained a high level of blood noradorenaline after a resection of the primary lesion and was successfully performed an excision of hepatic metastasis detected by a strict follow-up study. The patient was a 70-year-old man. When he was 65 years old, he was seen at the hospital because of lumbar pain, diagnosed as having left adrenal pheochromocytoma, and underwent an excision of the lesion with associated resection of the left kidney, pancreatic body and tail, and spleen. After the operation, hypertension and high level of blood noradrenaline persisted, but repeated explorations failed to detect metastasis. Five years later when he was 70 years old, a hepatic mass was first found out. Since it was solitary, a hepatectomy was performed. With a postoperative pathological study, hepatic metastasis of pheochromocytoma was diagnosed. After the operation, blood pressure as well as blood noradrenaline level were normalized.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(3), 671-675, 2002-03-25
Japan Surgical Association