肾上腺外恶性肿瘤伴发肾上腺原发肿瘤的临床特点

目的 了解肾上腺外恶性肿瘤伴发肾上腺原发肿瘤的临床特点.方法 1990年至2004年收治有恶性肿瘤病史或同期其他部位恶性肿瘤伴肾上腺原发肿瘤患者13例.男10例,女3例.中位年龄47岁.肾上腺肿瘤位于左侧6例、右侧4例、双侧3例.肿瘤最大直径中位数4.0cm.肾上腺外肿瘤分别为结直肠腺癌4例、甲状腺髓样癌3例、肺癌2例,乳腺癌、前列腺癌、膀胱癌和十二指肠类癌各1例.结果 原发肾上腺肿瘤13例,占同期肾上腺伴有恶性肿瘤病史或同期其他部位恶性肿瘤的30%(13/44).其中肾上腺皮质腺瘤8例、嗜铬细胞瘤3例、皮质腺癌和血管瘤各1例.8例皮质腺瘤中,B超、CT和MRI诊断准确率分别为3/8、3/7和4/4;3例嗜铬细胞瘤患者均为甲状腺髓样癌术后,B超、CT或MRI检查均确诊;1例肾上腺血管瘤B超、CT或MRI扫描均误诊为转移.失随访1例.伴发肾上腺腺瘤患者8例中,6例无瘤生存3～8年.嗜铬细胞瘤3例无瘤生存8～12年,但2例术后肾上腺皮质功能不全需要激素替代.肾上腺血管瘤患者术后长期生存12年.结论有恶性肿瘤病史患者伴发的肾上腺原发肿瘤以腺瘤多见,影像学是定性、定位诊断的主要手段.对于肾上腺外恶性肿瘤伴发孤立的原发与转移不明的肾上腺肿瘤,建议手术切除.     

肾上腺肿瘤的影像学诊断(附350例报告)

目的　提高肾上腺肿瘤的诊断水平。　方法　回顾 1 975年 5月～ 1 998年 5月收治的肾上腺肿瘤 35 0例临床资料 ,总结影像学检查与临床症候群、病理组织类型的关系。　结果　B超和CT对肾上腺肿瘤的定位诊断率分别为 85 %和 96 %。在皮质腺瘤、嗜铬细胞瘤及肾上腺皮质癌等不同的组织类型间 ,CT和MRI具有相对特异的表现。　结论　影像学检查可以提供肾上腺肿瘤的定位和定性诊断 ,在诊断和治疗中具有重要的应用价值。     

肾上腺外嗜铬细胞瘤：附13例报告

报告肾上腺外嗜铬细胞瘤13例,占同期嗜铬细胞瘤的35.1％。定位诊断首选B超,准确率达100％。全部病例均手术切除肿瘤,无手术死亡。长期严密的临床随访是诊断恶性嗜铬细胞瘤的主要依据。     

肾上腺偶发瘤临床分析

目的 总结肾上腺偶发瘤的临床、内分泌及病理学特点. 方法回顾性分析97例病理确诊肾上腺偶发瘤患者的临床资料.男53例,女44例.平均年龄45岁.肿瘤位于左侧38例、右侧52例、双侧7例.有较完整内分泌检测资料者74例.肿瘤最大直径由B超确定8例、CT确定54例、MRI确定35例. 结果 97例中恶性肿瘤20例(20.6%),其中肾卜腺皮质癌12例、恶性嗜铬细胞瘤3例、转移癌2例,肉瘤、神经母细胞瘤、恶性神经鞘瘤各1例;肾上腺皮质腺瘤26例(26.8%),良性嗜铬细胞瘤21例(21.6%),髓脂肪瘤9例(9.3%),肾上腺囊肿13例(13.4%),节细胞神经瘤5例(5.2%),神经纤维瘤3例(3.1%).高血压病患者40例(41.2%),功能性偶发瘤21例(28.4%).肿瘤直径<4 cm者25例(25.8%)、4～6 cm者33例(34.0%)、>6 era者39例(40.2%).肿瘤直径<4 cm者中恶性肿瘤仅1例(4%).恶性肿瘤直径(9.9±4.6)cm,良性肿瘤直径(5.6±3.2)锄(P=0.01).恶性肿瘤中直径>6 cm者15例(75.0%),良性肿瘤中27例(35.1%,P=0.001).恶性肿瘤患者体质量减轻者5例(25.0%),良性肿瘤者中2例(2.6%,P==0.004). 结论 肾上腺偶发瘤中皮质腺瘤、良性嗜铬细胞瘤和恶性肿瘤居前3他,偶发瘤均应进行详细的内分泌检测,肿瘤直径<4 cm足筛选无内分泌异常的偶发瘤随访时的一项重要指标.     

肾上腺肿瘤的影像学特征对手术方式选择的影响(附64例报告)

目的提高肾上腺肿瘤的诊断与治疗水平。方法回顾分析2003年5月～2005年5月吉林省梅河口市医院及孙逸仙纪念医院泌尿外科收治的肾上腺肿瘤病人64例临床资料,总结影像学特征与手术方式选择的关系。结果B超和CT及MRI对肾上腺肿瘤的定位诊断率分别为85%和96%及92%。在皮质腺瘤、嗜铬细胞瘤及肾上腺皮质癌等不同的组织类型间,CT和MRI具有相对特异的表现;肿瘤直径<6cm的通过腹腔镜下成功切除。肿瘤直径大于6cm的和诊断为恶性肿瘤的采取开放手术成功切除。结论影像学检查可以提供肾上腺肿瘤的定位和部分定性诊断,对手术方式的选择提供良好依据。腹腔镜手术是目前肾上腺良性肿瘤切除的金标准。直径大于6cm的肿瘤和考虑恶性的肿瘤最好采用开放手术。     

肾上腺偶发瘤的诊治

目的探讨肾上腺偶发瘤的诊断步骤和治疗方法的选择。方珐回顾性分析手术证实的129例肾上腺偶发瘤的临床资料。结果129例中125例完整切除肿瘤，肿瘤直径1．2—18cm。嗜铬细胞瘤31例，皮质腺瘤37例，皮质癌9例，转移癌4例，淋巴瘤3例，其他良性肿瘤45例。结论肾上腺偶发瘤中大部分为皮质和髓质肿瘤，因此需在术前做内分泌检查，确定有无功能；对直径大于3cm的无功能肿瘤及有功能或疑有恶变的需手术治疗；而小于3cm无功能肿瘤可定期随访。     

肾上腺嗜铬细胞瘤的诊断与手术治疗

目的：提高肾上腺嗜铬细胞瘤的诊断与外科治疗水平。方法：对109例经手术治疗的肾上腺嗜铬细胞瘤患者的临床资料进行回顾性分析，其中具有典型儿茶酚胺症临床表现者104例，24h尿VMA定性检查106例，99例增高，阳性率为90．8％，B超、CT及MRI定位诊断阳性率分别为89．0％、92．7％及100％。106例经开放手术切除肿瘤，3例行后腹腔镜肿瘤切除术。结果：经病理检查证实，良性102例(93．6％)，恶性7例(6．4％)，本组无手术死亡病例。结论：肾上腺嗜铬细胞瘤主要根据临床表现、生化定性检查及影像学定位检查明确诊断。手术切除肿瘤是唯一有效的措施，术前充分准备是确保手术成功的重要因素。应用腹腔镜技术切除肾上腺肿瘤具有广阔的应用前景。     

45例嗜铬细胞瘤的临床分析

目的：提高嗜铬细胞瘤的诊断和治疗水平。方法：回顾性分析10年来45例嗜铬细胞瘤的临床资料。结果：具有典型临床表现者39例(87％)。尿香草基苦杏仁酸和血儿茶酚胺定性诊断阳性率为73％，93％。B超、CT、MRI定位诊断阳性率为90％，96％，95％。肾上腺嗜铬细胞瘤35例(78％)，肾上腺外嗜铬细胞瘤10例(22％)。良性嗜铬细胞瘤39例(87％)，恶性嗜铬细胞瘤6例(13％)。全部患者均经手术成功切除肿瘤，无手术死亡患者。结论：嗜铬细胞瘤主要根据临床表现、实验室定性检查及影像学检查明确诊断。手术切除肿瘤是惟一有效的措施，充分的术前准备是确保手术成功的关键。术后应长期严密随访。     

嗜铬细胞瘤175例临床分析

目的探讨嗜铬细胞瘤的诊断和治疗。方法对175例嗜铬细胞瘤进行了回顾性分析,其中肾上腺嗜铬细胞瘤145例,肾上腺外嗜铬细胞瘤27例。有典型儿茶酚胺症临床表现者166例,24 h尿VMA阳性率为86.3%,B超、CT定位诊断率分别为95.9%及94.3%。结果170例行开放手术切除肿瘤,5例经后腹腔镜切除肿瘤。全组均经病理证实为嗜铬细胞瘤,其中良性163例,恶性12例,无手术死亡病例。结论嗜铬细胞瘤主要依据临床表现、生化定性检查及影像学定位检查明确诊断,术前准备极为重要,术中应严密监测和处理血压波动,同时应重视预防及正确处理手术并发症。     

肾上腺偶发瘤的外科治疗选择

目的 探讨肾上腺偶发瘤的手术指征.方法 总结147例肾上腺偶发瘤患者资料,分析偶发瘤的手术指征,比较腹腔镜和开放性手术的适应证.147例患者中,恶性肿瘤19例(12.9%),平均直径(8.5±3.9)cm,≤4 cm者4例(21.1%),其中肾上腺皮质癌15例、恶性嗜铬细胞瘤4例;良性功能性肿瘤29例(19.7%),平均直径(4.1±2.1)cm,其中≥3 cm者22例(75.9%);19例良性嗜铬细胞瘤中24 h尿香草扁桃酸升高2例,5例醛固酮瘤中血钾稍低2例,5例亚临床库欣综合征腺瘤患者血皮质醇升高,均无明显内分泌异常症状;良性无功能性肿瘤99例(67.3%),其中肾上腺皮质腺瘤61例(61.6%).结果 147例均行手术治疗.腹腔镜下手术组102例,开放性手术组45例,2组肿瘤直径分别为(3.4±1.8)cm和(6.7±1.5)cm(P＜0,0001);手术并发症发生率分别为5.9%(6/102)和15.6%(7/45)(P=0.1103).腹腔镜中转开放手术5例(4.9%),主要见于黏连严重的恶性肿瘤或肿瘤直径＞6 cm者.结论 肾上腺偶发瘤常见类型为无功能肾上腺腺瘤、嗜铬细胞瘤、肾上腺皮质癌.可疑恶性、有内分泌功能、直径≥3 cm的肾上腺偶发瘤应积极手术治疗.腹腔镜手术创伤小、恢复快,为手术首选;肿瘤直径＞6 cm、黏连严重、可疑恶性者应以开放性手术为主.     

Adrenal Incidentalomas: Experience in a Developing Country

BACKGROUND: The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India. METHODS: This is a retrospective study (January 1991-December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 +/- 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis RESULTS: Mean age of the patients was 46 +/- 12 years (M:F = 1:1.1). The incidentaloma measured more than 3 cm in 91% of cases and more than 6 cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography (n = 41), and remaining by CT scan (n = 10), and MRI (n = 2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%). CONCLUSION: In our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.     

Characterization of adrenal incidentaloma discovered with tomography. General review

The detection of an incidentaloma at abdominal Computed Tomography (CT), except CT features that permit a specific diagnosis (hemorrhage, myelolipoma or cyst), become a problem to differentiate adenomas from "non adenomas" (primary or secondary malignancy) incidentalomas. A density of ten Hounsfield units or less with a nonenhanced CT is a feature of benign incidentaloma (essentially lipid-rich adrenal adenomas). There are two limitations of this characterization: incidentalomas initially detected at enhanced CT and lipid-poor adrenal adenomas. The relative enhancement washout on enhanced CT, by using a threshold of 50% washout, permit then to characterized as adenomas or "non adenomas" incidentalomas on a 10-minute-delayed enhanced CT. Limitations of this characterization are only for benign pheochromocytomas and atypical adrenal cortical carcinomas.     

肾上腺偶发瘤128例临床分析

目的 提高肾上腺偶发瘤的早期诊断与鉴别诊断水平,指导临床治疗.方法 回顾性分析1996年3月至2010年3月在我院健康体检或因肾上腺以外疾病就诊而发现的128例肾上腺偶发瘤患者的资料.男60例,女68例.年龄20～75岁,平均50岁.肿瘤直径＜3 cm者63例,3～6cm者56例,＞6 cm者10例.128例患者均行血生化、电解质和肾上腺皮、髓质代谢检测及腹部超声、CT检查;6例行MRI检查.128例均行手术治疗.结果 128例术后病理诊断肾上腺皮质腺瘤85例,嗜铬细胞瘤13例,肾上腺囊肿8例,神经节瘤、髓样脂肪瘤各7例,肾上腺皮质结节状增生4例,肾上腺皮质癌2例,肾上腺皮质嗜酸细胞瘤、神经鞘瘤、肾上腺脂肪肉瘤各1例.其中1例嗜铬细胞瘤患者术中死于低血压休克,未计入总例数.结论 肾上腺偶发瘤术前定性诊断困难,对于直径＞6 cm及功能性偶发瘤应积极手术治疗.

Abstract：

Objective To improve the early diagnosis and differential diagnosis of adrenal incidentalomas to guide clinical management of this disease. Methods One hundred and twenty-eight cases were diagnosed as adrenal incidentalomas due to health examination or treatment of other than adrenal disease,including 60 males and 68 females,whose ages were between 20 and 75 years,with a mean age of 50 years.Tumor diamer:＜3 cm 63 cases,3-6 cm 6 cases,＞6 cm 10 cases.128 patients all had biochemical and electrolyte examination,adrenal cortex and medulla biochemical testing,abdominal ultrasound and CT examination,6 cases with MRI examination.Surgery and post operative pathological examination were performed in all patients. Results Post operative pathology finally diagnosed adrenocortical adenoma in 85 cases,pheochromocytoma in 13 cases,adrenal cyst in 8 cases,paraganglioma and myeiolipoma in 7 eases respectively,adrenal nodular hyperplasia in 4 cases,adrenocortical carcinoma in 2 cases,adrenoconical oncocytoma,cellular Schwannoma and adrenal liposarcoma in 1 case,respectively.One case of pheochromocytoma patients died of intraoperative hypotension,which is not included in the total number. Conclusions The preperative diagnosis of adrenal incidentalomas is difficult.For adrenal incidentalomas with diameter more than 6 cm and those with endocrine function,early surgicM treatment is recommended.     

肾上腺腺瘤型原发性醛固酮增多症149例

目的提高肾上腺腺瘤型原发性醛固酮增多症(简称原醛症 )的诊治水平. 方法回顾性分析1978～2001年2月收治的149例经手术和病理证实的肾上腺腺瘤型原醛症患者诊断治疗及预后的临床资料. 结果腹膜后充气造影、B超和CT在肾上腺腺瘤型原醛症诊断中的特异性分别为39.0%、67.0%和95.3%,腹膜后充气造影与B超和CT诊断特异性比较,差异有显著意义(χ2=23.89,P＜0.01),B超与CT诊断特异性比较差异有显著意义(χ2=32.10,P＜0.01).术后1个月所有患者血钾恢复正常,术后2个月内11 0例(73.8%)患者血压恢复正常. 结论 B超和CT检查是肾上腺腺瘤型原醛症定位诊断的主要方法,手术是主要的治疗手段,腹腔镜肾上腺切除术是一种很有前途的治疗方法.影响疗效的因素,主要与患者年龄大、病史长、全身血管硬化有关.     

偶发性肾上腺肿瘤29例报告

为提高偶发性肾上腺肿瘤的诊断和治疗水平，对29例偶发性肾上腺肿瘤进行分析。29例中，手术时偶然发现1例，B超扫描发现25例，CT检查发现28例。28例行手术治疗，1例未手术。结果27例患者痊愈，无术后并发症。提示CT可作为偶发性肾上腺肿瘤首选影像学诊断，B超可作为筛选诊断。偶发性恶性肾上腺肿瘤以转移癌多见，而原发性肿瘤极罕见。对确诊为恶性肿瘤、功能性肿瘤及直径＞4cm的肿瘤应积极采取手术治疗，术中应警惕偶发性嗜铬细胞瘤的潜在危险；对非功能性、直径＜4cm的肿瘤可行CT随访。     

A rare cavernous hemangioma of the adrenal gland

INTRODUCTION

Cavernous hemangiomas of the adrenal gland are rare. We report a case of a cavernous hemangioma of the adrenal gland presenting as an adrenal incidentaloma suspicious for adrenal cortical carcinoma (ACC).

PRESENTATION OF CASE

A 78 year old woman was admitted after a fall. Abdominal computed tomography revealed a large right adrenal lesion with features suspicious for adrenal cortical carcinoma (5.4 cm × 3.3 cm, unilateral, tumor calcifications, average Hounsfield units 55). The tumor was removed intact by a laparoscopic approach and pathology revealed a cavernous hemangioma of the adrenal gland.

DISCUSSION

Adrenal incidentalomas are found in up to 10% of patients undergoing abdominal imaging. Differential diagnosis includes both benign and malignant lesions. Guidelines for removal of adrenal incidentalomas recommend surgery based on functional status, size, and presence of concerning features on diagnostic imaging. Cavernous hemangiomas are rare, benign vascular malformations which can be challenging to distinguish pre-operatively from malignant lesions such as ACC.

CONCLUSION

Cavernous hemangiomas of the adrenal gland are exceedingly rare. These benign tumors have imaging features which may be suggestive of adrenal cortical carcinoma. The treatment of choice is surgical excision due the difficulty of excluding malignancy.     

肾上腺偶发瘤27例

目的 提高对肾上腺偶发瘤的诊治水平。方法 对27例肾上腺偶发瘤的临床资料进行分析。结果 27例中,B超诊断21例,占77.8％,CT及MRI检查发现6例。27例均行手术治疗,效果满意。结论 在健康查体时应常规作肾上腺B超,对肾上腺偶发瘤直径>2.0cm者应手术治疗,而直径<0.2cm者可定期随访。