肾上腺外嗜铬细胞瘤的超声诊断及病理对照研究

目的探讨超声检查对肾上腺外嗜铬细胞瘤的诊断价值及其病理基础。 方法超声检查并经手术证实的肾上腺外嗜铬细胞瘤24例，腹膜后19例，膀胱5例。 结果腹膜后嗜铬细胞瘤多发生于肾门及腹主动脉旁，低回声，有包膜，可见无回声区，临床症状不典型；病理观察：肿瘤形态规则，有包膜，切面实性，多见出血及囊变，细胞胞浆丰富，结缔组织分割主细胞呈巢状；膀胱嗜铬细胞瘤位于膀胱黏膜下，呈均匀低回声，局部膀胱黏膜连续，瘤体内血流丰富，临床症状典型；病理观察：肿瘤形态规则，有包膜，切面实性、细腻，瘤细胞胞浆丰富，呈片状细胞球样排列。 结论肾上腺外嗜铬细胞瘤病理结构决定声像图有一定的特点，肿瘤位于腹膜后，结合好发部位及多发囊变，术前应想到本病，肿瘤位于膀胱，临床病史典型，超声图像有一定的特异性，不难作出诊断。

Study of Extra-adrenal Pheochromocytoma: Ultasonography vs Pathology

Objective To study the ultrasonographic fetaures and pathological bases of extra-adrenal pheochromocytoma.Methods The ultrasonographic fetures of 24 cases(19 retroperitoneal pheochromocytoma,5 bladder pheochromocytoma)were analyzed and compared with the results of pathology.Results The focal sites of retroperitoneal pheochromocytoma included the area surrounding abdominal aorta and kidney.The tumors showed the fetaures of well-shaped,echogenic capsule,hypoechoic,coarse echotexture of the parenchyma and internal cystic areas.The patients were asymptomatic.Pathologically,the tumor shapes were regular and encapsulated.The cut surface was solid,hemorrhagic and cystic changes.Microscopically,tumor cells had plenty of cytoplasma and were separated by fibrovascular stroma into distinct nests.Bladder pheochromocytoma showed the features of well-shaped,homogeneous echogenic capsule.Flows were abundant on CDFI.The patients were with hyperadrenergic symptoms.Pathologically,the tumors were regular and encapsulated.The cut surface was solid,soft and homogeneous.Microscopically,tumor cells had plenty of cytoplasma arranged in well defined nests called Zellballen. Conclusions The patholotical bases of extra-adrenal pheochromocytoma determined the ultrasonographic features.The common sites and several internal cystic areas were useful signs for diagnosis.Accurate diagnosis of bladder pheochromocytoma is not difficult by combination of the ultrasonographic features and clinical hyperadrenergic simptoms.