Noguchi Go, Saito Yoko, Mitome Taku, Umemoto Susumu, Kakazu Ayano, Sugiyama Tomoko, Ueki Teiichiro
The Department of Urology, Japanese Red Cross Hadano Hospital.
The Department of Urology, Yokosuka Kyosai Hospital.
Hinyokika Kiyo. 2017 Apr;63(4):151-155. doi: 10.14989/ActaUrolJap_63_4_151.
A 67-year-old female was hospitalized with back pain. Computed tomography (CT) incidentally revealed a tumor in her left kidney tumor (33 mm) and bilateral breast tumors. She underwent a breast biopsy and was diagnosed with breast cancer (invasive lobular cancer, cT2N0M0). The renal tumor was suspected to be clear cell carcinoma, cT1aN0M0, based on contrast-enhanced CT. Surgery was considered necessary for both the breast cancer and renal tumor. First, laparoscopic radical nephrectomy was performed for the renal tumor. However, the lateroconal fascia adhered strongly to the perirenal fat, and so simple nephrectomy was carried out after conversion to open surgery. The perirenal fat was also excised after the nephrectomy. A histopathological examination revealed clear cell carcinoma and renal invasion by invasive lobular cancer cells. Also, scattered metastases were detected in the perirenal fat and the lateroconal fascia. So, it was considered that retroperitoneal metastases from the breast cancer had directly invaded the kidney. After the operation, the patient received hormonal therapy for her breast cancer, and she was still alive and symptom-free 5 months after the operation.
一名67岁女性因背痛入院。计算机断层扫描（CT）偶然发现她左肾有一个肿瘤（33毫米）以及双侧乳腺肿瘤。她接受了乳腺活检，被诊断为乳腺癌（浸润性小叶癌，cT2N0M0）。基于增强CT，肾肿瘤疑似为透明细胞癌，cT1aN0M0。乳腺癌和肾肿瘤都被认为有必要进行手术。首先，对肾肿瘤实施了腹腔镜根治性肾切除术。然而，侧锥筋膜与肾周脂肪紧密粘连，因此在转为开放手术后进行了单纯肾切除术。肾切除术后也切除了肾周脂肪。组织病理学检查显示为透明细胞癌以及浸润性小叶癌细胞侵犯肾脏。此外，在肾周脂肪和侧锥筋膜中检测到散在转移灶。所以，认为乳腺癌的腹膜后转移直接侵犯了肾脏。术后，患者接受了乳腺癌激素治疗，术后5个月仍存活且无症状。
