臨床泌尿器科68巻10号

2014年09月発行

綜説

小径腎腫瘍の自然史

著者： 舛森直哉¹

所属機関： ¹札幌医科大学医学部泌尿器科学講座

ページ範囲：P.727 - P.740

文献概要

要旨　小径腎腫瘍（small renal mass：SRM）とは，腎臓に発生した最大径4cm以下の造影される腫瘤と定義される。SRMの大部分は腎細胞癌であるが，一部には腎血管筋脂肪腫などの良性腫瘍が混在する。画像診断や経時的な腫瘍の増大速度のみから悪性・良性の鑑別を正確に行うことは困難である。腫瘍生検の有用性も報告されているが，腫瘍全体の組織型を反映しないなどの問題点も指摘されている。SRMの自然史の結果の集積により，SRMに対する治療オプションとして監視療法が成立することがわかってきた。ただし，cT1aの腎細胞癌であっても，病理学的には被膜浸潤を示したり，異型度の高い腫瘍が少なからず混在している。また，稀ながらも経過観察中に転移も認められる。したがって，現時点では監視療法の適応は高齢者，合併症により手術リスクが高い症例，十分なインフォームド・コンセントが行われた症例に限るべきである。

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