肾上腺无功能瘤

肾上腺无功能瘤指因非肾上腺疾病而行影像学检查时意外发现的肾上腺肿瘤，多数为无功能的良性肿瘤，部分为恶性或具有恶性潜能。常见类型主要包括：①肾上腺皮质来源疾病，包括腺瘤、结节样增生、癌等；②肾上腺髓质来源疾病，包括嗜铬细胞瘤、神经节瘤、成神经节细胞瘤等；③其他少见肿瘤，如淋巴瘤、错构瘤、畸胎瘤、纤维瘤、髓脂瘤等；④囊肿、假性囊肿、血肿、肉芽肿等；⑤肾上腺转移癌等。     

人肾上腺和肾上腺肿瘤组织的内皮素受体

为了解人肾上腺及其肿瘤组织中内皮素（ＥＴ）受体的分布及临床意义，用受体放射配体结合分析法（ＲＢＡ），测定了正常肾上腺（６例）、醛固酮瘤（５例）、特发性肾上腺皮质增生（４例）及嗜铬细胞瘤（６例）组织的ＥＴ－１受体和受体结合特性。结果表明，在上述组织中虽都存在单一位点的高亲和力ＥＴ－１受体，但醛固酮瘤的受体数较正常肾上腺明显减少（Ｐ＜０．０１），而解离常数（Ｋｄ）值相同；嗜铬细胞瘤的受体数较正常肾上腺、醛固酮瘤及特发性增生明显增多（Ｐ＜０．０１），受体亲和力却稍有下降。提示醛固酮瘤存在ＥＴ－１受体下调，ＥＴ在不同的肾上腺激素分泌中可能有重要的旁分泌和自分泌调节作用。     

细胞因子在肾上腺髓质及嗜铬细胞瘤中的作用

肾上腺髓质可产生多种细胞因子,它们在嗜铬细胞的分化、成熟及生长、功能方面以及在嗜铬细胞瘤的发病机制中起重要作用。其中,成纤维细胞生长因子(FGF)-2、胰岛素样生长因子(IGF)和神经生长因子(NGF)可刺激髓质嗜铬细胞增殖,而转化生长因子(TGF)-β对其增殖起负性调控作用。NGF、FGF-2和胶质细胞源性的神经营养因子(GDNF)均可促进嗜铬细胞分化,形成神经轴突样突触。IGF、TGFα和GDNF在嗜铬细胞瘤中的表达较正常肾上腺髓质明显增多,可能参与了嗜铬细胞瘤的发病。另外,血管内皮生长因子(VEGF)、白介素(IL)-1和IL-6在正常肾上腺髓质中也表达,但它们在髓质中的功能尚不甚清楚。肿瘤坏死因子(TNF)α在肾上腺皮质中表达,可能通过旁分泌作用调节髓质功能。     

CD_(44)在正常肾上腺组织及肾上腺肿瘤中的表达

探讨了ＣＤ４４（一种细胞表面糖蛋白）在肾上腺皮质各层组织，肾上腺髓质及肾上腺肿瘤中的表达。研究对象为１２例肾上腺皮质腺瘤、３例肾上腺皮质癌、１０例嗜铬细胞瘤患者及４例健康对照者。经福尔马林固定、石腊包埋所有研究对象的肾上腺组织，并制成切片，用单克隆抗...     

细胞因子在肾上腺髓质及嗜铬细胞瘤中的作用

肾上腺髓质可产生多种细胞因子，它们在嗜铬细胞的分化、成熟及生长、功能方面以及在嗜铬细胞瘤的发病机制中起重要作用。其中，成纤维细胞生长因子(FGF)-2、胰岛素样生长因子(IGF)和神经生长因子(NGF)可刺激髓质嗜铬细饱增殖，而转化生长因子(TGF)-β对其增殖起负性调控作用。NGF、FGF-2和胶质细胞源性的神经营养因子(GDNF)均可促进嗜铬细胞分化，形成神经轴突样突触。IGF、TGFα和GDNF在嗜铬细胞瘤中的表达较正常肾上腺髓质明显增多，可能参与了嗜铬细胞瘤的发病。另外，血管内皮生长因子(VEGF)、白介素(IL)-1和IL-6在正常肾上腺髓质中也表达，但它们在髓质中的功能尚不甚清楚。肿瘤坏死因子(TNF)α在肾上腺皮质中表达，可能通过旁分泌作用调节髓质功能。     

肾上腺外嗜铬细胞瘤25例临床分析

目的 分析肾上腺外嗜铬细胞瘤的发病情况，病理特征及诊断方法，探讨治疗措施。方法 通过对81例经手术与病理证实的嗜铬细胞瘤进行回顾性分析。结果 81例嗜铬细胞瘤患者中，经手术与病理证实的肾上腺外嗜铬细胞瘤25例，占同期收治嗜铬细胞瘤的30．9％。病人的临床表现除特殊部位肿瘤外与肾上腺髓质嗜铬细胞瘤相似。结论 肾上腺外嗜铬细胞瘤临床表现与生化诊断与肾上腺髓质嗜铬细胞瘤相似，其恶性者较肾上腺髓质嗜铬细胞瘤明显增多，定位诊断以^131I-MIBG为特异，治疗以手术最佳。     

肾上腺

553079 嗜铬细胞瘤的诊断和处理(38例经验总结)/刘任等//湖南医学。-1985,2(5)。-10～2 报告手术洽疗嗜铬细胞瘤37例、肾上腺髓质及皮质增生1例。持续性高血压型18例,阵发性高血压型20例。9例误诊为癫痫、颅内占位性病变、脑血管病等。3例扪及腹部包块。31例作24小时尿香草基扁桃酸(VMA)检查,24例阳性或增高,1例可疑。32例作尿儿茶酚(CA)试验,25例阳     

肾上腺髓质原前体肽段(22-41)(PAMP)的研究进展

１９９３年日本学者Ｋｉｔａｍｕｒａ等人在人的嗜铬细胞瘤（ｐｈｅｏｃｈｒｏｍｏｃｙｔｏｍａ，ＰＣ）中发现并分离和鉴定了一种新的生物活性肽，因其首先从肾上腺髓质的ＰＣ组织中被分离出来，并且大量存在于正常肾上腺髓质和ＰＣ组织中，故命名为肾上腺髓质素（ａｄｒ...     

恶性嗜铬细胞瘤的治疗进展

嗜铬细胞瘤是发生于肾上腺髓质和肾上腺外交感神经系统的肿瘤,其典型症状是阵发性高血压或持续性高血压阵发性加重。嗜铬细胞瘤发病率很低,每100万人中2-8人发病,在高血压人群中仅占0.1%。嗜铬细胞瘤80%-85%来源于肾上腺,15%-20%来源于肾上腺外的嗜铬组织（SPGLs）,SPGLs分布范围广泛,以腹膜后主动脉旁最多见。约20%的嗜铬细胞瘤是恶性的,     

肾上腺“意外瘤”的诊断与治疗

我院近４年经Ｂ超和（或）ＣＴ诊断为肾上腺“意外瘤”共１２例。其中７例作了手术，有功能者３例。病理切片检查，嗜铬细胞瘤３例，双侧皮质腺瘤、混合瘤、平滑肌瘤和皮质腺癌各１例。对肾上腺“意外瘤”的诊断和治疗进行了讨论。     

Ki67和FHIT在肾上腺皮质肿瘤组织中的表达及相关性研究

应用免疫组化方法检测15例肾上腺皮质腺癌、42例肾上腺皮质腺瘤、6例肾上腺皮质增生及10例瘤旁正常组织标本中Ki67及FHIT的表达情况.结果 显示Ki67在肾上腺皮质腺癌表达最高,腺瘤次之,瘤旁正常组织和增生组织中均不表达;FHIT在瘤旁正常肾上腺组织表达最高,增生和腺瘤次之,腺癌最低,Ki67和FHIT在肾上腺皮质肿瘤表达的结果比较差别有统计学意义(P<0.05),呈负相关关系(r=-0.712,P<0.05).Ki67的过表达与FHIT的表达缺失可能共同参与了肾上腺皮质腺癌的发生和发展.联合检测Ki67和FHIT的表达在临床上有助于肾上腺皮质肿瘤良、恶性的鉴别.     

Immunoreactive human chromogranin A in diverse polypeptide hormone producing human tumors and normal endocrine tissues

Chromogranin A, the major soluble protein costored and coreleased by exocytosis with catecholamines from the adrenal medulla, has recently been detected in several bovine polypeptide hormone producing tissues. We therefore searched for chromogranin, by immunohistology, in human polypeptide hormone producing tumors as well as normal human endocrine tissues. The chromogranin A antigen was purified from catecholamine storage vesicles of human pheochromocytoma, to which rabbit antisera were developed, allowing immunohistologic studies by the indirect rabbit anti-peroxidase technique. Specific chromogranin staining was noted in all polypeptide hormone producing human tumors studied (pheochromocytoma chromaffin cells, n = 3; medullary thyroid carcinoma parafollicular C cells, n = 2; thyroidal C cell hyperplasia cells, n = 1; parathyroid adenoma chief cells, n = 1; pancreatic islet cell tumor islet cells, n = 1; oat cell carcinoma cell line M-103) as well as in all normal polypeptide hormone producing tissues (adrenal medulla chromaffin cells, parathyroid chief cells, thyroid parafollicular C cells, pancreatic islet cells, gut enteroendocrine cells, and anterior pituitary cells). Chromogranin may have a widespread distribution in human polypeptide hormone producing tissues, and may be a useful histologic marker for peptide producing tumors.     

11C]metomidate positron emission tomography of adrenocortical tumors in correlation with histopathological findings

CONTEXT: Adrenal incidentalomas are common findings necessitating extensive laboratory work-up and repetitive radiological examinations. Positron emission tomography (PET) using (11)C-labeled metomidate (MTO) has previously been described as a tool for specific adrenocortical imaging. OBJECTIVE: We evaluated 212 MTO-PET examinations in 173 patients to identify its role in the management of adrenal tumors. DESIGN: Seventy-five histopathological examinations from 73 patients were retrospectively analyzed. SETTING: All examinations were performed at a referral center. PATIENTS: Patients who were operated or biopsied due to adrenal tumors had histopathological diagnoses of adrenocortical adenoma (n = 26), adrenocortical cancer (ACC; n = 13), adrenocortical hyperplasia (n = 8), pheochromocytoma (n = 6), metastasis (n = 3), and tumors of nonadrenal origin (n = 19). MAIN OUTCOME MEASURES: The main outcome measures were statistical analyses and findings while scrutinizing images. The hypothesis that MTO-PET is of value in the management of adrenal tumors, especially incidentaloma, was stated before data collection. RESULTS: Sensitivity was 0.89 and specificity was 0.96 for MTO-PET in proving adrenocortical origin of the lesions. Pheochromocytomas, metastases to the adrenal gland, and nonadrenal masses were all MTO negative. PET measurements using standardized uptake values (SUV) in pathological adrenocortical tissue could differentiate lesions larger than 1-1.5 cm from normal adrenocortical tissue. SUV was higher in aldosterone-hypersecreting adenomas, and the SUV ratio between the tumor and the contralateral gland was significantly higher in all hormonally hypersecreting adenomas as well as in ACC. CONCLUSION: MTO-PET is a specific and sensitive method for diagnosing adrenocortical tumors. MTO-PET is useful in the imaging work-up of adrenal incidentalomas and may be beneficial for the examination of patients with primary aldosteronism or ACC.     

Adrenal cortical adenoma and adrenal medullary hyperplasia of the right adrenal gland--a case report

The normal adrenal gland contains two types of tissue, the adrenal cortical tissue and the adrenal medullary tissue. The cortex is divided into three portions: the outermost "zona glomerulosa," the central "zona fasciculata," and the innermost "zona recticularis." The adrenal medulla is a developmentally separate organ, derived from neuroectoderm, and is the site of epinephrine and norepinephrine production. Adrenal cortical adenoma is commonly the result of a basophilic tumor of the anterior pituitary that secretes excessive amounts of ACTH. Adrenal medullary hyperplasia (or pheochromocytoma) are clinically hazardous tumors because of their excessive secretion of catecholamines. Combined adrenal cortical adenoma and adrenal medullary hyperplasia of the right adrenal gland has never been described previously.     

Ki-67和P21在肾上腺皮质癌中的表达及意义

目的　探讨肾上腺皮质癌 (ACC)中Ki 67和P2 1的表达及其意义。方法　采用免疫组化SP法和图像分析技术对 8例正常肾上腺组织、2 0例肾上腺腺瘤 (ACA)、19例肾上腺皮质癌中Ki 67、P2 1进行检测。结果　Ki 67和P2 1的表达在肾上腺腺瘤与肾上腺皮质癌间差异均有统计学意义 (P <0 .0 1,P <0 .0 5 )。Ki 67的表达与肾上腺皮质癌分期、浸润或转移、2年生存情况相关(P <0 .0 1) ,与肿瘤大小无关 (P >0 .0 5 )。P2 1的表达与肾上腺皮质癌的大小、分期、浸润或转移、2年生存情况均无显著相关 (P >0 .0 5 )。结论　Ki 67和P2 1对肾上腺皮质良恶性肿瘤具有重要的鉴别诊断作用 ,Ki 67可作为判断肾上腺皮质癌预后不良的指标。     

肾上腺皮质肿瘤VEGF、TSP-1的表达及其与微血管密度的关系

目的 研究血管内皮生长因子(VEGF)、血小板反应素1(TSP-1)在肾上腺皮质肿瘤中的表达及其与微血管密度(MVD)的关系.方法 采用免疫组化方法检测13例肾上腺皮质癌、30例肾上腺皮质腺瘤和7例正常肾上腺组织中VEGF、TSP-1及MVD(以CD34为标记)的表达.结果 肾上腺皮质癌VEGF表达高于肾上腺皮质腺瘤,差异有统计学意义(P＜0.01);TSP-1在正常肾上腺皮质表达明显高于肾上腺皮质癌(P＜0.01);MVD在肾上腺皮质癌为(107.67±11.91)/视野,显著高于肾上腺皮质腺瘤(59.46±21.31)/视野和正常肾上腺皮质组织(25.10±3.94)/视野(均P＜0.01);VEGF的表达与MVD呈正相关(P＜0.01),TSP-1的表达与MVD呈负相关(P＜0.01),VEGF与TSP-1的表达呈负相关(P＜0.01).结论 VEGF和TSP-1在肾上腺皮质肿瘤的表达失衡是其肿瘤血管异常生成的重要原因.     

肾上腺皮质增生症患者肾上腺皮质组织ACTH的表达与血浆ACTH的关系

目的探讨ACTH在正常和增生的肾上腺皮质组织中的表达状况,了解增生的肾上腺皮质组织中ACTH的表达水平与患者血浆中ACTH浓度之间的关系。方法应用免疫组织化学方法(SP法)检测上述不同肾上腺皮质组织中ACTH的表达水平,并利用计算机图像分析技术进行半定量分析。用放免法检测肾上腺皮质增生症患者血浆ACTH的浓度,并与肾上腺皮质组织中局部表达ACTH的水平进行相关性分析。结果ACTH非依赖性肾上腺皮质增生症皮质组织的ACTH表达水平,明显高于ACTH依赖性肾上腺皮质增生症皮质组织和正常肾上腺皮质组织(均P<0.05);ACTH依赖性肾上腺皮质增生症患者皮质组织中ACTH的表达水平与其血浆ACTH的浓度之间有明显负相关(r=-0.87,P<0.05),而在ACTH非依赖性肾上腺皮质增生症患者二者之间无明显相关(r=0.17,P>0.05)。结论人正常肾上腺皮质组织局部有ACTH的表达,局部ACTH的过表达可能参与ACTH非依赖性肾上腺皮质增生症的发生过程;ACTH依赖性肾上腺皮质增生症患者血浆高水平的ACTH影响皮质组织局部ACTH的表达。     

The role of immunohistochemistry in histopathological diagnostics of clinically "silent" incidentally detected adrenal masses.

BACKGROUND: The detectability of adrenal incidentalomas (incidentally found adrenal tumours) in the whole population is estimated at 0.1%; 0.42% in non-endocrine patients and at 4.3% in oncologically diagnosed ones. Even up to 16% of incidentalomas of adrenal glands can be malignant lesions. The issue of crucial importance is the histopathological differentiation between benign lesions and malignant tumours of the adrenal cortex and medulla. OBJECTIVES: To evaluate whether the immunohistochemical analysis of the expression of p53, p21, PCNA and Ki67 in the tumour's tissue can be useful in the histopathological diagnostics of adrenal incidentalomas and whether it is important for prognosis. MATERIAL AND METHODS: Our series consisted of 74 tumour samples from 164 patients operated for incidentalomas. There were 43 cortical adenomas, 11 cortical adrenocarcinomas and 20 PHEOs (including 5 malignant lesions). Using monoclonal antibodies, the expression of p53, p21, PCNA and Ki67 was evaluated. RESULTS: We found a statistically significant correlation between the expression of p53, p21, Ki67 and the differential diagnosis of adrenal cortical adenoma and adrenocortical carcinoma (for proteins: p53 p=0.010, for p21 p=0.010, for Ki67 p<0.001). The statistical significant correlation between PCNA protein and diagnosis of adrenal cortical adenoma and adrenocortical carcinoma was not found. The statistically significant correlation between p21, PCNA proteins and the diagnosis of benign and malignant PHEOs was not estimated. There was no expression of Ki67 or p53 protein above the assumed level in benign and malignant pheochromocytomas. The statistically significant correlation between p53, p21, PCNA or Ki67 and the occurrence of metastases in adrenocarcinoma and malignant PHEOs was not found.     

Pheochromocytoma associated with adrenocortical tumor in the same gland. Two case reports and literature review

Pheochromocytomas are catecholamine-producing neuroendocrine tumours arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglionic system that show 2 distinctive features, rarity and clinical variability. Pheochromocytoma occasionally is associated with pathological lesions of the adrenal cortex. We present 2 cases of patients referred to our hospital with a finding of clinical suspected pheochromocytoma. Both of them were hypertensive; the first patient with typical symptoms of pheochromocytoma and the second patient with chest pain and hypertension resistant to pharmacological treatment. The diagnosis of pheochromocytoma was confirmed in both cases with laboratory analysis and the lesion was achieved by employing 3 imaging techniques: computed tomography (CT), magnetic resonance imaging (MRI) and scintigraphy with (123)I-metaiodobenzilguanidine (MIBG). The patients underwent adrenalectomy and in the same adrenal gland we found a pheochromocytoma associated with a nonfunctioning cortical adenoma. As far as we know few cases with this association are available in the literature.     

原发性醛固酮增多症肾上腺皮质病变中两种来源的血管内皮生长因子的表达及意义

目的 检测内分泌腺源性血管内皮生长因子(EG-VEGF)和血管内皮生长因子(VEGF)在原发性醛固酮增多症(原醛症)肾上腺皮质病变中的表达及其关系.方法 采用免疫组化和实时荧光定量PCR法检测24例原醛症肾上腺皮质病变和8例正常肾上腺皮质组织EG-VEGF、VEGF的表达,并采集临床资料,分析其表达水平与原醛症临床病理特征之间的关系.结果 醛固酮瘤EG-VEGF、VEGF mRNA和蛋白表达高于原醛症皮质增生及正常肾上腺皮质(均P＜0.05),后两组差异无统计学意义(P＞0.05).在原醛症肾上腺皮质病变,EG-VEGF、VEGF的蛋白表达与血浆醛固酮水平相关(P＜0.05),EG-VEGF与VEGF之间的表达相关(P＜0.01).结论 EG-VEGF和VEGF对原醛症皮质肿瘤的形成、发展可能起重要作用.

Abstract：

Objective To investigate the expression and significance of the endocrine gland-derived vascular endothelial growth factor (EG-VEGF) and vascular endothelial growth factor(VEGF) in adrenocortical lesions of primary aldosteronism. Methods The expressions of EG-VEGF, and VEGF were detected by immunohistochemistry and real-time fluorescence quantitative PCR in samples of 18 cases of adrenocortical adenoma, 6 adrenocortical hyperplasia, and 8 normal adrenal cortex. The correlation between the expressions of EG-VEGF, VEGF, and clinicopathological parameters was analyzed. Results The expression of EG-VEGF or VEGF in adrenocortical adenomas was higher than that in adrenocortical hyperplasia or normal adrenal cortex ( all P＜0. 05 ), and the expression of EG-VEGF or VEGF between adrenocortical hyperplasia samples and normal adrenal cortex samples was indistinctive. There was no statistically significant correlation between EG-VEGF or VEGF expression and sex, age, blood pressure, serum potassium, plasma renin activity, except in case of serum aldosterone( P＜0.05 ). A positive correlation between EG-VEGF and VEGF ( P＜0. 01 ) was found. Conclusions EG-VEGF and VEGF may play a significant role in the formation and development of adrenocortical tumors in primary aldosteronism.