肾上腺嗜酸细胞腺瘤1例报告并文献复习

目的:探讨肾上腺嗜酸细胞腺瘤的临床及病理特点。方法:回顾性分析1例肾上腺嗜酸细胞腺瘤患者的临床资料:男,54岁,体检时B超发现左肾上腺区肿物,CT检查发现6.0cm×5.3cm肾上腺区肿物。肾素、醛固酮、儿茶酚胺实验值均正常。行肾上腺肿物切除术。结果:术中发现肿物体积较大,包膜完整光滑,与周围组织无粘连,肿物表面血管较为丰富,术中触碰肿物,血压无波动,遂完整切除肿物。术后病理检查显示肿瘤细胞嗜酸性,内部充满颗粒,诊断为肾上腺嗜酸细胞腺瘤。随访6个月无复发。结论:肾上腺嗜酸细胞腺瘤是一种具有潜在恶性的良性肿瘤,可手术切除,但术后需密切随访。     

肾上腺异位副脾经腹膜后腹腔镜切除1例

患者,女,36岁.入院前半个月B超发现左肾上腺区肿物,无任何症状,CT检查示左肾上腺占位性病变7.7 cm×5.5 cm,分界清,强化不均,中心密度低,入院后查彩超示左肾上腺肿瘤,血供丰富,检查24 h尿17-羟类固醇,17-酮类固醇,香草苦杏仁酸,血皮质醇,肾素,血管紧张素,醛固酮均正常.     

肾上腺异值副脾经腹膜后腹腔镜切除1例

患者 ,女 ,36岁。入院前半个月B超发现左肾上腺区肿物 ,无任何症状 ,CT检查示左肾上腺占位性病变 7.7cm× 5 .5cm ,分界清 ,强化不均 ,中心密度低 ,入院后查彩超示左肾上腺肿瘤 ,血供丰富 ,检查 2 4h尿 1 7 羟类固醇 ,1 7 酮类固醇 ,香草苦杏仁酸 ,血皮质醇 ,肾素 ,血管紧张素 ,醛固酮均正常。术前诊断左肾上腺肿瘤。在全麻下经腹膜后行腹腔镜单纯肿物切除术 ,术中见肿物表面光滑 ,与肾上腺无粘连。术后病理诊断异位副脾。术后复查B超示左肾上腺区未见肿块 ,脾脏正常。讨论　副脾一般多位于脾门附近 ,与主脾结构相似 ,无症状的副脾无须处…     

von Hippel-Lindau综合征外科治疗

目的 探讨von Hippel-Lindau(VHL)综合征的外科治疗方法.方法 VHL综合征患者4例.例1,男,56岁.主诉乏力、心悸2 d.空腹血糖2.37 mmol/L.CT检查示左肾上、下极3个肿块,直径分别为8.0、7.0、4.0 cm.10年前行脑血管母细胞瘤切除术.例2,女,57岁.主诉左腰痛不适1个月.CT检查示左肾上腺、左肾、胰体肿物,直径分别为2.7、4.5、2.1 cm.例3,女,39岁.查体发现左肾上腺占位1个月.CT检查示左肾上腺3.0 cm×4.0 cm实性占位,增强后肿块明显强化.既往有小脑、脊髓血管母细胞瘤及双侧肾癌手术史.例4,女,41岁.B超发现双肾肿瘤1个月入院.CT检查示左肾、左肾上腺、右肾、胰腺肿物,直径分别为4.0、3.0、1.5、2.0 cm.1个月前行y刀治疗多发脑部肿瘤.结果 4例均手术治疗.例1行左肾根治性切除术,病理报告肾血管周细胞瘤,随访6个月右肾未见异常.例2行左肾、左肾上腺、胰体尾及脾切除,病理报告肾透明细胞癌、胰岛细胞瘤、肾上腺囊肿,随访3个月MRI检查发现脊髓肿瘤.例3行左肾上腺肿瘤摘除术,病理报告嗜铬细胞瘤,随访2年未见肿瘤复发.例4行左肾、左肾上腺切除,病理报告肾透明细胞癌、肾上腺嗜铬细胞瘤,3周后剜除右肾肿瘤,病理报告透明细胞癌,随访1年肿瘤未复发.结论 VHL可并发多器官肿瘤,较大中枢神经系统肿瘤可手术切除,多发较小的实性肿瘤可放疗.直径<3cm肾癌可密切随访、择期处理;直径>3cm肾癌首选保留肾单位手术.肾上腺肿瘤首选腺瘤摘除术,避免肾上腺全切术.腹部多器官肿瘤一期手术安全可行. 理报告肾透明细胞癌、胰岛细胞瘤、肾上腺囊肿,随访3个月MRI检查发现脊髓肿瘤.例3行左肾上腺肿瘤摘除术,病理报告嗜铬细胞瘤,随访2年未见肿瘤复发.例4行左肾、左肾上腺 除,病理报告肾透明细胞癌、肾上腺嗜铬细胞瘤,3周后剜除右肾肿瘤,病理报告透明细胞癌,随访1年肿瘤未复发.结论 VHL可并发多器官肿瘤,较大中枢神经系统肿瘤可手术切除,多发较小的实性肿瘤可放疗.直径<3cm肾癌可密切随访、择期处理;直径>3cm肾癌首选保留肾单位手术.肾上腺肿瘤首选腺瘤摘除术,避免肾上腺全切术.腹部多器官肿瘤一期手术安全可行. 理报告肾透明细胞癌、胰岛细胞瘤、肾上腺囊肿,随访3个月MRI检查发现脊髓肿瘤.例3行左肾上腺肿瘤摘除术,病理报告嗜铬细胞瘤,随访2年未见肿瘤复发.例4行左肾、左肾上腺 除,病理报告肾透明细胞癌、肾上腺嗜铬细胞瘤,3周后剜除右肾肿瘤,病理报告透明细胞癌,随访1年肿瘤未复发.结论 VHL可并发多器官肿瘤,较大中枢神经系统肿瘤可手术切除,多发较小的实性肿瘤可放疗.直径<3cm肾癌可密切随访、择期处理;直径>3cm肾癌首选保留肾单位手术.肾上腺肿瘤首选腺瘤摘     

肾上腺囊肿伴髓质出血1例报告

患者,女,47岁,以“间歇性头晕,头胀不适2月”之主诉入院。B超示:左肾上腺囊肿,而CT示左肾上腺腺瘤(考虑原醛)。24小时尿17-羟类固醇为22.5μmol,17-酮类固醇为109.5μmol,VMA为43.09μmol,血、尿钾均正常,血压高为22/14kPa,经口服降压药后血压降至正常。术中见左肾上腺表面有一约2×2cm~2大小的囊肿,囊液清亮。完整剥除,     

巨大肾上腺皮质嗜酸细胞腺瘤(附1例报告)

目的 探讨肾上腺皮质嗜酸细胞腺瘤的诊断与治疗方法.方法 报道经治的一例巨大肾上腺皮质嗜酸细胞腺瘤的临床资料,并结合文献复习进行讨论.患者术前血压、血皮质醇等检查均正常,行彻底肿瘤切除.结果 完整切除巨大肿瘤,术后病理证实为右侧肾上腺皮质嗜酸细胞腺瘤,患者术后恢复良好,无并发症发生.结论 肾上腺皮质嗜酸细胞腺瘤属罕见肿瘤,多为良性,缺乏典型的临床表现及实验室检查,手术切除是首先的治疗手段.     

肾上腺皮质嗜酸细胞癌的临床特点及诊疗对策(附2例报告)

目的:总结肾上腺皮质嗜酸细胞癌(adrenocortical oncocytic carcinoma,AOC)临床特点、诊断标准、治疗方法以及预后。方法:报告AOC 2例,并通过Pubmed、CNKI数据库进行文献复习。结果:1例无症状女患者,CT提示左肾上腺9cm肿物;另1例患者男,腰疼,左肾上腺30cm肿物。2例患者相关内分泌检查均无异常。女患者接受腹腔镜左肾上腺肿物切除术,男患者接受经腹开放左肾上腺肿物切除。2例术后病理均提示肿物以嗜酸性细胞为主,有核异型性、核分裂相>5/HPF,包膜及血管浸润,免疫组化提示组织来源于肾上腺皮质。根据Bisceglia改良标准,AOC诊断成立。结论:AOC临床罕见,目前国内外共24例散发报道,治疗以手术为主,病理检查为其主要诊断方法,术后辅助治疗的方案及效果尚无定论,AOC恶性度低,预后较好。     

精索副神经节瘤一例报告并文献复习

目的 提高对精索副神经节瘤诊断和治疗的认识.方法 报道1例精索副神经节瘤患者,并复习文献.患者38岁,因发现左侧阴囊内肿物20余年,阴囊坠胀不适数年入院.查体发现左侧精索静脉重度曲张及左精索上部占位性病变.B超提示左精索静脉曲张,左精索上方实质性结节,境界清楚,大小约2.0 cm×2.5 cm,周围血供丰富.结果 行左精索静脉高位结扎术及左精索肿物切除术.术中见精索肿物呈圆形结节,边界清楚,质中,将左精索肿物及其包膜完整切除.病理组织学表现为瘤细胞弥漫,呈不典型的车辐状或编织状排列,细胞大小形态较一致,胞质丰富,弱嗜酸性,核大淡染,核分裂象易见,并可见病理性核分裂象;间质为丰富的血管和淋巴细胞和单核细胞等炎细胞浸润;瘤细胞局部浸润边缘平滑肌.免疫组织化学检查示波形纤维蛋白、嗜铬粒蛋白A、突触运载蛋白均阳性.病理诊断为精索副神经节瘤.术后随访18个月,无复发及转移.结论 精索副神经节瘤确诊需依赖病理组织学检查,良恶性判别尚无统一标准,须完整切除肿瘤,尤其是年轻未育者,术后长期密切随访.     

肾脏异位肾上腺皮质腺瘤1例报告并文献复习

目的:提高对肾脏异位肾上腺皮质腺瘤的认识和诊疗能力。方法:对收治的1例肾脏异位肾上腺皮质腺瘤患者的诊治经过进行回顾性分析，总结临床经验，并结合文献进行复习归纳，分析术前误诊原因。结果:患者因“恶心、纳差4 d”入院，术前影像学检查提示肾上腺占位，血醛固酮升高，血钾降低，考虑肾上腺醛固酮瘤，术中见肿瘤来源肾脏上极，与肾上腺分界清楚，行3D腹腔镜右肾部分切除手术，术后病理报告(右肾肿物)皮质腺瘤。经过4个月的术后随访，患者血醛固酮、血钾恢复正常，无并发症。结论:肾脏异位肾上腺皮质腺瘤罕见，最终需要手术及病理确诊。肾脏上极异位肾上腺肿瘤或增生，容易误诊，发现后应进行手术确诊，尽可能采用肾部分切除术。     

肾上腺囊性嗜铬细胞瘤三例报告

1983～1997年收治肾上腺囊性嗜铬细胞瘤3例,报告如下。例1,男,63岁。因左上腹不适3个月入院。一般体检无异常发现。Ｂ超示左侧腹膜后、胰尾后方有一3.3ｃｍ×3.2ｃｍ低回声均匀块影,后方回声增强。ＣＴ示胰尾后方一直径3.2ｃｍ低密度均匀肿物,ＣＴ值4～9ＨＵ,包膜完整,增强后包膜强化,提示左肾上腺囊肿。24ｈ尿ＶＭＡ排出量正常。术前诊断为左肾上腺囊肿。全麻下行左肾上腺及肿瘤切除术,术中见左肾上腺有一椭圆形肿物,游离肿物时血压骤升,心率增快,考虑为嗜铬细胞瘤,予酚妥拉明和过量输血处理,切除肿瘤后,血压、心率降至正常。肿瘤为囊性,约…     

Robotic-assisted adrenalectomy for adrenal incidentaloma: case and review of the technique

An incidental left adrenal mass was found in a patient during an evaluation for mediastinal widening. The patient had no symptoms attributable to adrenal excess. Preoperative biochemical screening was negative for a functioning medullary or cortical adrenal tumor. Surgical resection was successfully completed with the assistance of the da Vinci robotic system. Pathology demonstrated a rare adrenal oncocytoma.     

False positive 18F-FDG PET scan in adrenal oncocytoma

18F-FDG whole-body positron emulsion tomography (18F-FDG PET) has become an established imaging modality for a variety of cancers. Today, 18F-FDG PET is utilized to differentiate benign from malignant non-functioning adrenal masses. In this report, a 25-year-old woman presented with a 2-month history of left flank pain. Abdominal CT revealed a left 6.5 x 4.5 cm adrenal mass with regular margins and focal calcification. To make a differential diagnosis, 18F-FDG PET was performed. Preoperative laboratory studies showed that the mass was non-functioning. A left adrenalectomy was performed through a left subcostal incision. The final pathologic evaluation revealed adrenal oncocytoma. We present the disassociation between preoperative 18F-FDG PET and pathologic findings of a benign adrenocortical oncocytoma.     

Concurrent occurrence of three primary neoplasms with different hystotype in the same kidney, associated with an adenoma of the omolateral adrenal gland: First case report

We present an unusual case of concurrent occurrence of three synchronous primary tumors in the same kidney (oncocytoma, chromophobe renal cell carcinoma, angiomyolipoma) associated to an adenoma of the omolateral adrenal gland in a patient with no evident clinical symptoms. The immunohistochemistry showed a positivity for KIT in oncocytoma and chromophobe cell carcinoma, and a weak positivity in the angiomyolipoma, only in the cells positive for HMB-45. This is the first report of this kind of presentation.     

Two cases of renal oncocytoma

Two cases of renal oncocytoma are reported. These patients were a 67-year-old man and a 74-year-old man who had incidentally been indicated to have a right renal mass lesion by echography in other hospitals. In both cases, enhanced computed tomographic scan showed a low density renal mass. In selective renal angiogram of the two cases, a spoke-wheel configuration of vessels could be seen in one case, but there was no evidence of renal mass in another. Total nephrectomy was performed in each case. Two masses were pathologically diagnosed as oncocytoma, constructed of large eosinophilic cells with granular cytoplasm and small regular nuclei. These two patients have been well for more than 2 years after the surgery. These are the 25th and 26th cases of renal oncocytoma reported in Japan before December, 1988.     

Laparoscopic approach to a large adrenocortical oncocytoma: A case report and review of the literature

INTRODUCTIONAdrenocortical oncocytomas are extremely rare tumors, considered to be non-functional and of low malignant potential. Despite the great advance in laparoscopic techniques, there are extremely limited reports of laparoscopic approach of adrenocortical oncocytomas. Herein is presented a challenging case of laparoscopic approach to a large adrenocortical oncocytoma, underlining the safety and feasibility of laparoscopy in the surgical management of these extremely rare adrenal tumors.PRESENTATION OF CASEA 34 year-old male was referred for surgical evaluation after the incidental discovery of a large right adrenal mass, during ultrasound examination due to renal colic. Further imaging evaluation revealed a well circumscribed capsule around the mass was demonstrated, with no evidence of infiltration of the neoplasm to periadrenal tissues. The patient was scheduled for laparoscopic right adrenalectomy, running an uneventful postoperative period. Histopathology revealed the presence of an adrenal oncocytoma.DISCUSSIONRecent studies have demonstrated that approximately one third of adrenocortical oncocytomas are associated with hormonal hypersecretion, as well as that one fifth of them demonstrate malignant biological behavior. From this point of view, there is emerging evidence in favor of the necessity of surgical excision as the treatment of choice. In spite of the progress of laparoscopic surgery, only three cases of laparoscopic excision of these tumors have been reported up to date.CONCLUSIONLaparoscopic surgery offers a safe alternative in confronting adrenocortical neoplasms, even when the biological behavior of the tumors cannot be pre-operatively evaluated in a definite way.     

Retroperitoneoscopic partial adrenalectomy for large adrenocortical oncocytoma

A young woman had mild hypertension, and on evaluation, a large tumor arising from the right adrenal gland was found. The tumor was hormonally inactive. Retroperitoneoscopic partial adrenalectomy was carried out. The histopathology report described adrenocortical oncocytoma.     

Nonfunctioning adrenal cortical adenoma: a case report

A 49-year-old female was admitted for evaluation of the abdominal mass which had been incidentally found by ultrasonography during the work up of diabetes mellitus. There was no evidence suggesting hormonal hyperactivity along with the clinical symptoms and the laboratory data. CT scan revealed a small round mass over the right renal upper pole which was in homogeneously enhanced by contrast dye. Right adrenal venography showed the round mass compressing the right adrenal central vein, and hormonal sampling in several portions of the venous system gave unremarkable results. The abdominal mass was resected and the histologic diagnosis was benign adrenal cortical adenoma. This case of nonfunctioning adrenal cortical adenoma is presented, and the management of asymptomatic adrenal tumors incidentally found was discussed.     

Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta‐analysis

To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta‐analysis. In all, 10 RMB series, including institutional data, were included in the meta‐analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies (I² = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.     

Adrenocortical Oncocytoma — A Rare Tumor of Undefined Malignant Potential: Report of a Case

Adrenocortical oncocytomas are exceptionally rare. To our knowledge, only 23 cases have been reported in the world literature, most of which were benign and nonfunctioning. We report a case of adrenocortical oncocytoma diagnosed by pathological examination of an extirpated right adrenal mass in a young woman. We discuss this case and review the literature on this unusual entity.