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Giant mediastinal tumors may cause fatal respiratory failure or circulatory collapse at the time of induction of general anesthesia and sometimes require extracorporeal life support. However, it is unclear whether preoperative percutaneous drainage of tumor contents for a giant mediastinal cystic teratoma reduces these risks. We report a case of a giant mediastinal cystic teratoma in which general anesthesia could be safely induced without extracorporeal life support by preoperative percutaneous drainage that reduced most of the tumor volume under local anesthesia. A 41-year-old woman diagnosed with a ruptured giant mediastinal teratoma required urgent surgery. To avoid circulatory collapse, preoperative percutaneous drainage of the tumor contents was performed, which successfully evacuated most of the tumor volume. General anesthesia was induced without any problem, and mediastinal tumorectomy was performed. We argue that it is worth attempting percutaneous drainage of tumor contents before cannulation of extracorporeal life support.

症例は77歳男性. 平成14年12月糖尿病性腎症による慢性腎不全の診断で紹介受診. 初診時BUN 48mg/dL, Cre 3.3mg/dLであったが徐々に腎機能は低下した. 感冒を契機に急性増悪し, 全身浮腫と両胸水を認め, 平成16年1月血液透析に導入した. 発熱, 肉眼的血尿, CRP高値も認めていたが確定診断に至らず, 抗生剤投与で軽快したため退院とした. その後近医で外来維持透析療法を受けていたが, しばしば発熱, CRP陽性を認め抗生剤投与を受けていた. 同年6月右胸痛と右胸水を認めるようになり精査目的で第2回目の入院となった. 入院後, 各種抗生剤に抵抗性の発熱, CRP高値, 全身倦怠感が持続し, 顕微鏡的多発血管炎 (microscopic polyangitis: MPA) を疑ってMPO-ANCAを測定した結果, 高値 (503 EU) であった. ステロイド大量療法を行った結果, 解熱, CRP低下, 胸水減少と著明に改善した. 確定診断には至らなかったが, 臨床経過よりMPAによる胸膜炎が考えられた.

Knowledge of the characteristics and effective use of tumour markers for mesothelioma is essential for early-stage diagnosis of mesothelioma. We examined whether renal dysfunction influences blood concentrations of promising new tumour markers, N-ERC/mesothelin (N-ERC) and osteopontin (OPN), to an important degree.Levels of serum N-ERC and plasma OPN in 32 patients with chronic renal dysfunction, 22 of whom were on hemodialysis (CKD group), and 102 healthy volunteers were measured.Serum concentrations of N-ERC and plasma concentrations of OPN in the CKD group were significantly higher than those in volunteers, regardless of diabetes status and age. Blood concentrations of these markers increased as renal function decreased.N-ERC and OPN concentrations are significantly influenced by renal function. Therefore, the extent of renal failure must be considered when inferring the existence of tumours and chemotherapeutic response from the values of these markers in routine practice.