原发性无功能肾上腺皮质癌的诊断治疗

目的:探讨原发性无功能肾上腺皮质癌的诊断治疗。方法:回顾性分析16例经影像学检查、手术及病理证实的原发性无功能肾上腺皮质癌临床资料。结果:本组16例患者,男6例,女10例,年龄平均47岁,肿瘤直径平均9.5cm。16例患者相关内分泌检查均提示无异常。B超显示肿瘤内回声和形态多不规则,MRI,CT总体表现为肿瘤形状不规则,边界不清晰,肿瘤内部密度不均匀,增强后周边明显强化。临床分期Ⅰ期1例;Ⅱ期6例;Ⅲ期6例;Ⅳ期3例。16例患者均行手术治疗。术后病理均证实为肾上腺皮质腺癌。术后随访4例至今存活。结论:B超、CT、MRI可帮助诊断原发性无功能肾上腺皮质癌。积极手术是确切的治疗手段。50岁以上人群应以B超等影像检查监测肾上腺,以便早期发现。

Diagnosis and Treatment of Primary nonfunctioning Adrenal Cortical Carcinoma

Objective:To investigate the cause,diagnosis,and treatment of primary nonfunctioning adrenal cortical carcinoma(ACC).Methods:The clinical data of 16 patients(6 male,10 female) who underwent adrenalectomy for primary nonfunctioning ACC based on the imaging,surgical and pathological evidence at our institution between 1995 and 2006 were reviewed.Results:Median age was 47 years.The mean size of all lesions was 9.5 cm.There were no symptoms from hormone activity.Ultrasonography showed that the tumor was irregular in echogenicity and shape.CT and MRI typically demonstrated irregular margins and variable enhancement of margins after intravenous contrast media.1 was clinical stage I,6 were clinical stageⅡ,6 were clinical stage Ⅲ,and 3 were clinical stage Ⅳ.Surgical resection was performed.Histopathologic examination ruled out adrenal cortical carcinoma.Operations were performed in 12 cases with good results.During postoperative follow-up that was available for 4 patients until now.Conclusion:Ultrasound,CT and MRI are effective in diagnosis and differential diagnosis of primary nonfunctioning adrenal cortical carcinoma.Surgery remains the mainstay for primary and recurrent disease.The adrenal gland in crowd above 50 years old should be inspected regularity,so that ACC can be early discovered.