晚期肾上腺皮质癌术前辅助治疗的临床分析

Preoperative adjuvant therapy of advanced adrenocortical carcinoma

目的探讨米托坦对晚期肾上腺皮质癌术前辅助治疗的效果及意义。方法2008年7月及2012年1月2例晚期。肾上腺皮质癌患者术前采用米托坦辅助治疗。例1，女，24岁，出现库欣症状1年，双下肢水肿1个月。CT检查于右侧肾上腺可见巨大实性占位，大小约10．0cm×7．8cm，内见钙化，周围结构受压，肿瘤局部与下腔分界不清，增强扫描可见不均匀强化，下腔静脉内可见可疑充盈缺损。行右肾上腺肿物穿刺活检，病理回报：少许肾上腺皮质组织。诊断考虑为右肾上腺皮质癌伴腔静脉瘤栓。口服米托坦治疗6个月。例2，女，42岁，左肾上腺腺瘤切除术后9年，出现库欣症状2年，发现左腹膜后及腹壁占位6个月。CT检查见腹膜后脾。肾之间多发结节状软组织密度影，可见融合，最大截面积约8cm×12cm，上下径约14cm，内见点状钙化，增强后不均匀强化，另见右侧膈肌前方结节影，明显强化；右侧前腹壁腹膜与肌层可见结节影，不均匀强化，诊断左肾上腺皮质癌伴多发转移。口服米托坦治疗5个月。结果服用药物后2例患者库欣症状均明显好转，主要不良反应为恶心、呕吐、头晕、乏力、腹泻等，调整药物用量后缓解。复查CT见原发病灶及转移灶体积均明显缩小。行手术切除肿瘤及转移灶，术后病理报告为肾上腺皮质癌。2例患者术后分别随访7、42个月未见复发。结论米托坦对肾上腺皮质癌及其转移灶治疗效果确切，可使病灶明显缩小，库欣症状缓解，为外科治疗提供机会。

Objective To evaluate the effect of mitotane as a preoperative adjuvant therapy in advanced adrenocortical carcinoma. Methods Mitotane was used in 2 patients as preoperative adjuvant therapy. Case 1, a 24-year-old woman had Cushing＇s symptom for 1 year and presented with edema in both legs for 1 month. Computed tomography （CT） showed a solid mass in the right adrenal. It was about 10.0 cmx 7.8 cm with calcification, and the boundary of tumor was not clear. Enhanced CT scan showed heterogene- ous enhancement and there was a suspicious filling defect in the inferior vena eava. Biopsy of adrenal neo- plasm was made and pathological result was adrenocortical tissue. The patient was diagnosed as right adreno- cortical carcinoma with tumor thrombus in vena cava. Mitotane was used for 6 months. Case 2, a 42-year-old woman who underwent left adrenal adenoma resection 9 years ago, presented with Cushing＇s syndrome for 2 years, and found masses in left retroperitoneal and abdominal wall for 6 months. CT showed multiple nodular soft tissues with pitting calcification and fusion in it, locating between retroperitoneal spleen and kidney. The biggest section was approximately 8 crux 12 era, with a largest diameter of 14 era. Enhanced scan showed un- even density wiht CT value of about 32 HU. Nodule shadows which were obviously strengthened were found in front of the right side of the diaphragmatic muscle. And some heterogeneous enhanced nodule shadows could be seen in front of the right abdominal peritoneal and muscle layer. The patient was diagnosed as right adrcnocortical carcinoma with multiple metastases. Mitotane was used for treatment for 5 months. Results Both of their Cushing＇s symptom were significantly improved by taking drugs. The main side effects were nausea, vomiting, dizziness, fatigue, diarrhea and so o,i, but all could be alleviated after drug dosage adjust- ment. CT reexamination showed the volume of the primary lesion and metastases were significantly reduced. The postoperative pathological report after remove of the tumor and metastases showed adrenocortical carcino- ma. Followed up for 42 and 7 months, the patients had no recurrence. Conclusions Mitotane is effective as preoperative adjuvant therapy in adrenocortieal carcinoma and metastases. It can reduce the lesions significantly, relieve the Cushing＇s symptom, and provide opportunity for surgical treatment.