Kawamoto Shunji, Yoshida Takahisa
Dept. of Surgery, Fukuoka Tokushukai Medical Center.
Gan To Kagaku Ryoho. 2010 Nov;37(12):2614-6.
A 71-year-old man was admitted by systemically massive edema and advanced rectal cancer. His hemoglobin or serum albumin level was 7.5 g/dL or 1.2 g/dL. Proteinuria ranged from 1.8 to 3.8 g/day. Massive effusion in chest and abdomen was obvious with low oxygenation and unstable hemodynamic state. Renal biopsy showed membranous nephropathy. Abdomino-perineal resection of the rectum was performed. Specimens showed poorly differentiated adenocarcinoma. The classification was type 1, 90 × 85 mm, pAI (seminal grand), pN3, sH0, sP0, cM0: fStage IIIb. The nephrotic syndrome was evidently improved with no urinary excretion of albumin at forty-postoperative day. The perioperative management allowed a surgical resection to be undertaken that led the clinical curability in rectal cancer as well as nephrotic syndrome.
一名71岁男性因全身性重度水肿和晚期直肠癌入院。他的血红蛋白或血清白蛋白水平分别为7.5 g/dL或1.2 g/dL。蛋白尿范围为1.8至3.8 g/天。胸腹部大量积液明显，伴有低氧血症和血流动力学状态不稳定。肾活检显示为膜性肾病。行腹会阴联合直肠癌切除术。标本显示为低分化腺癌。分类为1型，90×85 mm，pAI（精囊），pN3，sH0，sP0，cM0：fStage IIIb。术后第40天，肾病综合征明显改善，无白蛋白尿排出。围手术期管理使得能够进行手术切除，从而实现了直肠癌以及肾病综合征的临床治愈。
