Kaneko Shuzo, Tsukamoto Yusuke, Abe Kazuya, Yonamine Masayuki, Hasegawa Sumiko, Hikida Hiromi
Department of Nephrology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan.
Department of Obstetrics and Gynecology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashiku, Tokyo, 174-0051, Japan.
CEN Case Rep. 2013 May;2(1):123-127. doi: 10.1007/s13730-012-0057-7. Epub 2013 Jan 26.
A 69-year-old woman was admitted to our hospital for rapid increase in serum creatinine level with microscopic hematuria and nephrotic-range proteinuria. Three months prior to admission, she became aware of atypical genital bleeding, leading her gynecologist to suspect endometrial cancer. Light microscopy examination of renal biopsy revealed crescentic glomerulonephritis with peritubular capillaritis. Immunofluorescence microscopic examination did not detect any significant staining, and no electron-dense deposits were detected by electron microscopy. No autoantibodies, including anti-myeloperoxidase- or anti-proteinase3-anti-neutrophil cytoplasmic antibodies were detected. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and was found to have endometrial neuroendocrine small cell carcinoma (NSCC), stage 1B. In her clinical course, her serum creatinine level gradually improved without immunosuppression therapy. Endometrial NSCC is a rare endometrial malignancy. This is the first case report of vasculitis associated with NSCC originating from the uterus.
一名69岁女性因血清肌酐水平迅速升高、镜下血尿和肾病范围蛋白尿入住我院。入院前三个月，她发现有非典型生殖器出血，妇科医生怀疑为子宫内膜癌。肾活检光镜检查显示为新月体性肾小球肾炎伴肾小管周围毛细血管炎。免疫荧光显微镜检查未发现任何显著染色，电镜检查未检测到电子致密沉积物。未检测到自身抗体，包括抗髓过氧化物酶或抗蛋白酶3抗中性粒细胞胞浆抗体。患者接受了全腹子宫切除术和双侧输卵管卵巢切除术，发现患有1B期子宫内膜神经内分泌小细胞癌（NSCC）。在她的临床过程中，未经免疫抑制治疗，其血清肌酐水平逐渐改善。子宫内膜NSCC是一种罕见的子宫内膜恶性肿瘤。这是首例起源于子宫的NSCC相关血管炎的病例报告。
