18例肾上腺皮质嗜酸细胞腺瘤患者的临床特征

Clinical features of 18 patients with adrenocortical oncocytoma

目的 探讨肾上腺皮质嗜酸细胞腺瘤临床特点,以提高临床认识.方法 回顾性分析本院1993年1月至2009年11月住院的586例肾上腺皮质腺瘤中术后病理证实为肾上腺皮质嗜酸细胞腺瘤的患者18例（男性7例,女性11例）,年龄（45.5±15.9）岁,病程（13.3±13.1）个月.结果 18例肾上腺皮质嗜酸细胞腺瘤患者中皮质醇增多症6例,原发性醛固酮增多症2例,皮质醇增多症合并原发性醛固酮增多症1例,无功能瘤9例.术前误诊为嗜铬细胞瘤4例.18例患者均经肾上腺超声诊断,均行手术治疗,其中腹腔镜手术13例,开腹手术5例,左侧11例,右侧7例,肿瘤平均直径5.6 cm.术后病理支持肾上腺皮质嗜酸细胞腺瘤,其中存在恶性倾向5例,恶性1例,良性12例.随访11例,随访时间（20.5±20.1）个月,死亡2例,存活9例,复发1例.结论 肾上腺皮质嗜酸细胞腺瘤是一病理诊断,临床表现多样,肿物体积多较大,多数可行超声检查发现,但易被误诊.与以往报道不同,本组病例以内分泌功能异常居多.该病多数为良性,但恶性倾向明显,需密切随访.

Objective To explore the clinical features of adrenocortical oncocytoma for better understanding. Methods A total of 586 patients with adrenal cortical adenoma were retrospectively analyzed in our hospital from January 1993 to November 2009, in which 18 were diagnosed as adrenal cortical oncocytoma pathologically, with 7 male and 11 female, aged （ 45.5 ± 15.9 ） years, and the disease course of（ 13.3 ± 13.1 ）months. Results 6 patients suffered from Cushing＇s syndrome, 2 primary hyperaldosteronism, 1 had clinical features of both Cushing＇s syndrome and primary hyperaldosteronism, and 9 were nonfunctional. 4 cases were misdiagnosed as pheochromocytoma preoperatively. All 18 patients were diagnosed by B-mode ultrasound and operation （ 13 by laparoscopy, 5 by laparotomy）. 11 tumors were located in the left adrenal while 7 in the right, with the average tumor size of 5.6 cm in diameter. Histopathologically, 1 was oncocytic adrenocortical carcinoma, while 17 were adrenocortical oncocytoma, in which 5 were potentially malignant and 12 were benign. 11 patients were followed up for 20.5±20.1 months. 2 patients were dead, and 9 were alive with tumor recurrence in 1 case. Conclusions Adrenocortical oncocytoma is a pathological diagnosis and the clinical manifestations are various. The tumors are usually large in size, and can easily be found by ultrasound, but may be wrongly diagnosed as pheochromocytoma. Being different from previous reports, the majority of these patients present with endocrine dysfunction. Most of these cases are benign, but malignant potential is obvious. Therefore,follow-up is very important.