日鼻誌 53 ⑴ 2014 the operation, embolization of the feeding artery the sphenopalatine artery was performed the day before surgery, markedly reducing bl

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1 原著 A Case of Nasal/Paranasal Metastatic Renal Cell Carcinoma Naoya Nishida, Hirotaka Takahashi, Kunihide Aoishi, Kiyofumi Gyo Depertment of Otolaryngology, Head and Neck Surgery, Ehime Univercity School of Medicine Metastatic renal cell carcinoma of the nasal cavity and paranasal sinus is relatively rarely reported. Recently, we encountered a case of metastasis of renal cell carcinoma to the nasal cavity and paranasal sinus nine years after surgery. An -year-old woman visited a clinic with a chief complaint of recurrent nosebleeds. She was diagnosed as having a dark-red hemorrhagic mass in the posterior right nasal cavity, was subsequently referred to our hospital for close examination and treatment of the tumor. An incisional biopsy revealed that the mass was a clear cell carcinoma, and thus a clinical diagnosis of renal cell carcinoma metastatic to the nasal cavity was made, as the patient s history included nephrectomy for renal cell carcinoma nine years prior and hepatectomy for metastatic liver tumor of renal cell carcinoma three years prior. Since the primary lesion in the kidney was being well controlled with pharmacotherapy and no hepatic metastasis was noted, surgical resection of the intranasal tumor was chosen as the preferred approach for treatment of the recurrent nosebleeds. Renal cell carcinoma tumor lesions are rich in blood supply, and in light of the possibility of massive bleeding during

日鼻誌 53 ⑴ 2014 the operation, embolization of the feeding artery the sphenopalatine artery was performed the day before surgery, markedly reducing blood flow to the lesion.

2 日鼻誌 53 ⑴ 2014 the operation, embolization of the feeding artery the sphenopalatine artery was performed the day before surgery, markedly reducing blood flow to the lesion. The nasal/paranasal tumor was removed endoscopically. The intraoperative bleeding volume was as low as 300 ml, and a blood transfusion was not required. Although metastatic lesions were detected in other organs after the operation, the patient remains alive at present (18 months post-surgery) despite the presence of tumors. She has not developed recurrent nosebleeds during the postoperative follow-up period. Although tumor metastasis to the nasal cavity and paranasal sinus is rare, the most frequent primary site of a metastatic nasal cavity and paranasal sinus tumor is reported to be the kidney. As such, physicians should consider the possibility of metastasis of renal cell carcinoma if a tumor mass is detected in the nasal cavity and paranasal sinus. Key words renal cell carcinoma, metastasis, nasal/paranasal tumor, nasal bleeding 2013年９月18日受稿 2014年２月26日受理はじめに MT 鼻副鼻腔悪性腫瘍のうち転移性腫瘍は1.5 と比較的まれであるが 1 そのうち原発臓器としては腎細胞癌が最多となっている2 腎細胞癌は血管に富む腫瘍で鼻腔転移すると多くは鼻出血をきたし患者のQOLを悪化させる腎細胞癌は比較的長期の経過を経て転移を認めることもあるため腎細胞癌の既往があり腫瘍が易出血性であれば腎細胞癌の転移を念頭に置く必要がある IT 今回われわれは腎細胞癌鼻副鼻腔転移例を経験したので若干の文献的考察を加え報告する症図１例 NS 初診時の鼻腔ファイバースコープ所見右鼻腔後方に拍動する暗赤色の腫瘤を認める 81歳女性主訴右鼻出血既往歴 74歳時に腎細胞癌淡明細胞癌に対し右腎生検後止血に難渋し経過観察のため同日入院となった摘出術を施行 79歳時に肝転移を認め肝右葉切除を施行生検の結果腎細胞癌淡明細胞癌の鼻腔転移と診断家族歴特記事項なしされた PET-CTを行ったが他部位に転移は認めな現病歴 X 1年11月頃から右鼻出血を反復するようかったよってこの時点では腫瘍摘出により根治が望めになり近医耳鼻科受診右鼻腔後方に拍動する暗赤色ることと手術により鼻出血のコントロールも得られるの腫瘤を認め精査加療目的にX年１月下旬当科を紹ことから手術を行うこととした腎細胞癌は血流に富む介受診した腫瘍であり術中の大量出血が予測されたため術前日に受診時現症右鼻腔後方に拍動する暗赤色の腫瘤を認血管造影および血管塞栓術を施行したセルジンガー法にめた図１て腫瘍の栄養血管である右側の蝶口蓋動脈を塞栓した初診時検査所見赤血球 /ml ヘモグロビン塞栓術後腫瘍への血流は著明に減少した図3a b g/dl ヘマトクリット31.5 と正球性正色素性貧血を手術所見手術は全身麻酔下に行ったまず鈎状突起認めた篩骨胞を切除し第III基板を開放すると腫瘍が露出腫画像所見副鼻腔造影CTにて鼻腔後方に強い造影効果瘍は後部篩骨洞から発生していた吸引剥離子を用いてを伴う腫瘤を認めた腫瘤は天蓋や上咽頭には接してい腫瘍を周囲より剝離し一塊として摘出した術中の出血なかった図2a b 量は約300mlで輸血は行わなかった臨床経過初診時外来にて腫瘤より生検を行った 2 病理組織学的所見図４粘膜下間質に小型円形核

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日 鼻 誌 53 ⑴ 2014 the operation, embolization of the feeding artery the sphenopalatine artery was performed the day before surgery, markedly reducing bl

日鼻誌 53 ⑴ 2014 the operation, embolization of the feeding artery the sphenopalatine artery was performed the day before surgery, markedly reducing bl