肾上腺恶性嗜铬细胞瘤12例临床分析

目的：总结对肾上腺恶性嗜铬细胞瘤的诊断及治疗的体会。方法;回顾性分析12例肾上腺恶性嗜铬细胞瘤的临床资料。结果：12例的24小时尿儿茶酚胺均有不同程度升高（690nmol/24h-1023nmol/24h),静脉肾盂造影提示肾上腺恶性嗜铬细胞瘤3例;单行B超或CT检查提示肾上腺恶性嗜铬细胞瘤分别为6例和5例;B超结合CT检查提示肾上腺恶性嗜铬细胞瘤7例。9例行手术治疗,病理检查结果确诊为肾上腺恶性嗜铬细胞瘤,术后平均存活期为8.5个月至38个月,中位数16个月;3例经儿茶酚胺检测,B超及CT检查诊断为肾上腺恶性嗜铬细胞瘤,因一般情况差或广泛远处转移未行手术,其中1例行化学治疗,均于9个月内死亡,结论：检测24小时尿儿茶酚胺,并行B超及CT检查是诊断本病的主要方法,手术治疗是首选的治疗措施。     

恶性嗜铬细胞瘤一例

1病例资料女,43岁。因左上腹痛2个月入院。有高血压病史8年,药物控制不理想。2年前行腹膜后肿瘤切除术。查体:血压200/140 mmHg。意识清,精神尚可。浅表淋巴结未触及增大。心、肺检查未见异常。腹平软,左侧肋缘下     

恶性嗜铬细胞瘤并转移一例

1　病历资料患者男 ,33岁 ,因高血压 5年 ,外院Ｂ超发现左肾上腺巨大肿物 6ｄ入院。查体 :血压 2 6 / 14.5ｋＰａ ,消瘦 ,面部颈部及四肢可见大面积弥漫性红色小丘疹。腹部未检出明显阳性体征。血常规正常。血生化 :总蛋白 4 9ｇ/Ｌ ,血糖 7.5ｍｍｏｌ/Ｌ ,乳酸脱氢酶 5 4 6Ｕ/Ｌ。 2 4ｈ间甲氧肾上腺素 (ＭＮ)、甲氧去甲肾上腺素 (ＮＭＮ)及香草扁桃体酸 (ＶＭＡ)均明显高于正常。ＣＴ :左肾上腺区可见一巨大占位性病变 ,平扫可见散在性钙化 ,增强后不均匀强化 ,左肾、胰体尾部及脾脏受压、变形、移位。肝实质内可见散在性大小不等低密影 ,…     

恶性嗜铬细胞瘤并转移一例

1 病历资料 患者男,33岁,因高血压5年,外院B超发现左肾上腺巨大肿物6 d入院.查体:血压26/14.5 kPa,消瘦,面部颈部及四肢可见大面积弥漫性红色小丘疹.腹部未检出明显阳性体征.     

膀胱嗜铬细胞瘤二例

1　病历例 1,男 ,4 2岁。因阵发性尿频、尿痛半年余并血尿 1周 ,偶感头痛、出汗 ,排尿后加重入本院治疗。体检 :血压 173/ 75mmHg ,膀胱区有深压痛。B超检查 :膀胱后壁探及 5 .0cm× 4 .1cm大小低回声团块。心电图 :窦性心动过速。CT :双肾及肾上腺无异常。行肿瘤及部分膀胱壁切除术。病理检查 :结节状肿物一个 ,附部分膀胱壁组织 ,大小约 5 .0cm× 4 .5cm× 4 .0cm ,被覆的膀胱黏膜上可见一直径 1.0cm浅表溃疡。切面呈囊实性 ,部分区域出血、囊性变 ,实性区淡褐色 ,质脆 ,与正常膀胱壁组织分界尚清。镜下观察 :肿瘤组织呈小叶状及条索状…     

膀胱恶性异位嗜铬细胞瘤误诊1例

1　病例报告女 ,12岁。发作性头痛 3a,全身抽搐 1个月 ,于 1992 - 10 - 0 4住院。 1989- 0 3某日无明显原因发作头痛 ,以枕部明显 ,呈胀痛 ,剧烈难忍 ,伴心悸、恶心 ,持续 3～ 5 min自行缓解 ,间歇期如常人。在某大医院就诊 ,血压正常 ,眼底正常 ,神经系统检查无阳性体征。 ECG:基本节律 8～ 10 Hz的α节律 ,波幅 2 0～ 5 0μv,各导联有少量低幅快波 ,并有阵发性棘 -慢波出现。按头痛性癫痫服用卡马西平、丙戊酸钠治疗 ,头痛再未发作。 1992 - 0 9- 11停用抗痫药物。 1992 - 0 9- 2 6平卧中突发强直—阵挛发作 ,伴意识丧失 ,持续 2～ 3min…     

膀胱嗜铬细胞瘤2例诊治报告

膀胱嗜铬细胞瘤临床上少见 ,较易误诊。由于嗜铬细胞瘤的围手术期处理较为特殊 ,术前术中不正确的处理 ,可造成患者死亡 ,而且膀胱嗜铬细胞瘤恶性倾向率高 ,文献报道２０．７ %～３８．５ %［１ ,２］ ,对于本病的术前诊断和围手术期治疗显得尤为重要。我院去年收治２例 ,均行手术治疗并经病理证实。报告如下。一、临床资料２例均为女性 ,年龄３６岁和５２岁 ,１例以无痛性肉眼血尿１天Ｂ超提示膀胱占位而入院 ,另１例高血压２年 ,间歇无痛性肉眼血尿３月 ,排尿时有时有心慌、胸闷、头痛、出汗等症状。膀胱镜检查 :肿瘤位于膀胱顶部和前壁 ,…     

嗜铬细胞瘤误诊1例分析

对嗜铬细胞瘤误诊1例分析如下。 1病历摘要 男，27岁。因突发双下肢无力去当地医院就诊，诊断为格林一巴利综合征？低钾血症（血钾2．5mmol／L），给予抗病毒、补钾治疗1周后恢复。半个月后，患者再次因双下肢无力来我院就诊。查体：T36．7℃，P89次／min，R20次／min，BP175／105mmHg。辅助检查：血、尿、大便常规、肝、肾功正常。血生化：血钾2．3mmol／L，余正常。心电图示：T波低平。B超检查示：     

合并重度麻痹性肠梗阻的恶性嗜铬细胞瘤1例

恶性嗜铬细胞癌以便秘、肠梗阻为突出表现临床少见。笔者曾遇1例，现报告如下。     

胰腺实性-假乳头状瘤超声表现1例

<正>患儿女,10岁。因不明原因上腹部胀痛不适,进食后加重3个月来我院就诊。体格检查:一般情况好,体温36.5℃,无恶心呕吐,无腹泻,无发热,寒战,大小便正常。巩膜及全身皮肤无黄染,无肝掌及蜘蛛痣,全身浅表淋巴结无肿大。腹软,平坦,上腹部有轻压痛,无反跳痛,肝脾胁下未及,肝脾区无叩痛,移动性波音(-),未见胃肠型及蠕动波,Murphy征(-),肠鸣音正常。超声检查:胰腺形态异常,胰体处可见范围约25 mm×20 mm的中等回声结节向腹侧     

Malignant pheochromocytoma with cerebral and skull metastasis: A case report and literature review

BACKGROUNDMalignant pheochromocytoma with cerebral and skull metastasis is a very rare disease. Combining our case with 16 previously reported cases identified from a PubMed search, an analysis of 17 cases of malignant cerebral pheochromocytoma was conducted. This literature review aimed to provide information on clinical manifestations, radiographic and histopathological features, and treatment strategies of this condition.CASE SUMMARYA 60-year-old man was admitted with a progressive headache and enlarging scalp mass lasting for 3 mo. Radiographic images revealed a left temporal biconvex-shaped epidural mass and multiple lytic lesions. The patient underwent a left temporal craniotomy for resection of the temporal tumor. Histopathological analysis led to identification of the mass as malignant pheochromocytoma. The patient’s symptoms were alleviated at the postoperative 3-mo clinical follow-up. However, metastatic pheochromocytoma lesions were found on the right 6^th rib and the 6^th to 9^th thoracic vertebrae on a 1-year clinical follow-up computed tomography scan.CONCLUSIONMagnetic resonance spectroscopy and histopathological examination are necessary to make an accurate differential diagnosis between malignant cerebral pheochromocytoma and meningioma. Surgery is regarded as the first choice of treatment.     

膀胱壁异位嗜铬细胞瘤1例

患者女,39岁,体检B超发现膀胱右侧壁异常回声.无高血压,无排尿时或排尿后心悸、冷汗.血、尿儿茶酚胺检查正常,无任何阳性体征.行膀胱镜检查发现膀胱右后壁可见一实性肿物,略呈灰白色、质硬、大小约1.5 cm,活检病理提示为炎性病变.     

Malignant hyperthermia: a case study

Malignant hyperthermia continues to be a life-threatening emergency that can occur without warning. With early discharge, this crisis may even occur at home. Perioperative, anesthesia, and Post-Anesthesia Care Unit (PACU) nursing staff need to be educated in the signs, symptoms, treatment, and care of a malignant hyperthermia patient. This is a US government work. There are no restrictions on its use.     

嗜铬细胞瘤合并肾上腺节细胞神经瘤一例

目的:分析嗜铬细胞瘤合并肾上腺节细胞神经瘤的诊治要点.方法:总结分析1例嗜铬细胞瘤合并肾上腺节细胞神经瘤的诊治经过.结果:该例患者有高血压、糖尿病病史,结合实验室检查及影像学检查可基本明确嗜铬细胞瘤,行后腹腔镜下肾上腺肿瘤切除术后,血压可降至正常范围,术后病理学检查符合混合性嗜铬细胞瘤和肾上腺节细胞神经瘤.结论:嗜铬细胞瘤合并肾上腺节细胞神经瘤是一种少见的良性肿瘤,临床症状以嗜铬细胞瘤表现为主,确诊靠病理学检查,手术切除是主要的治疗方法.     

Large dopamine-secreting pheochromocytoma: case report

Pheochromocytomas are rare tumors that typically present with catecholamine-stimulated symptoms. Some pheochromocytomas secrete dopamine in addition to or in the absence of other catecholamines. Patients with these tumors are frequently normotensive. We describe a normotensive 26-year-old woman with a large pheochromocytoma that secreted multiple catecholamines, including dopamine.     

原发性肝嗜铬细胞瘤1例

患者女,34岁,3年前体检发现血压升高(180/110mmHg),半年前出现心悸,起床活动及夜间排尿时明显,伴大汗及四肢无力,卧床数分钟可缓解。查24小时尿儿茶酚胺(CA)和香草基杏仁酸(VMA)均明显升高,但多次肾上腺超声及增强CT检查均无异常发现,患者家族中无类似病史。现血压160/120mmHg,24小时尿儿茶酚胺(μg)明显升高,NE1078.46,E16.99,DA130.80,临床表现支持嗜铬细胞瘤(pheochromocytoma)。为明确肿瘤部位行超声检查,仪器采用Philips i U22彩色多普勒超声诊断仪,探头频率3~5MHz。结果显示:双肾及肾上腺区、腹膜后大血管旁、膀胱壁等均未见…     

Malignant pheochromocytoma presenting as incapacitating bony pain

Among adrenal incidentalomas, pheochromocytomas are rare. Malignant pheochromocytoma is even less common, and it typically presents with classic hormonal symptoms, such as palpitations, labile blood pressures, and headaches. Bony metastasis usually occurs late in disease, but we report an unusual case of incapacitating bony pain as the initial presentation of malignant pheochromocytoma. Our patient is a 70-year-old woman with neurofibromatosis type 1 and a history of primary hyperparathyroidism, who tested negative for the ret mutation. She came to medical attention with chest pain and palpitations and was incidentally found to have an adrenal mass. Serum and urine testing was consistent with pheochromocytoma. Her blood pressure was easily controlled as she awaited elective adrenalectomy; however, she quickly developed severe, diffuse bony pain. She represented with hypercalcemia, spontaneous fractures, and incapacitating pain that required such high doses of pain medications that she had to be intubated. Further imaging and bone marrow biopsy confirmed metastatic neuroendocrine tumor. She received one round of chemotherapy with no change in her bony pain, which was her primary complaint. Unfortunately, her treatment options were limited by the heavy sedation required for comfort, and in the end, it was her bony pain rather than hormonal symptoms that made her disease untreatable.