肾上腺皮质腺癌的诊断与治疗

Diagnosis and treatment of adrenocortical carcinoma

目的 总结肾上腺皮质腺癌（ACC）的诊治经验,提高肾上腺皮质癌的诊治水平.方法 对5例ACC患者的临床表现、实验室及影像学检查、治疗和预后进行回顾性分析.结果 本组B超示肾上腺实质性中等回声,内部回声不均匀,可见点状血流反射;CT均示肿瘤边缘模糊,CT值32 ～ 65 HU,强化不均匀;MRI示肿瘤边界欠清,T2加权片上2例呈高信号,1例呈高低混杂信号,病灶中心坏死区无明显强化.5例均行开放性手术完全切除肿物,术后应用米托坦2例、放疗1例;术后随访6 ～ 36个月,平均生存23个月.结论 B超、CT等检查有利于ACC的早期诊断,手术切除是治疗ACC的有效方法.

Objective To conclude the diagnosis and treatment experience of adrenocortical carcinoma （ACC） and to improve the treatment level of ACC. Methods The clinical manifestations, laboratory and imaging examinations, treat- ment and prognosis of 5 patients were analyzed retrospectively. Results Type-B ultrasonic of this group showed parenchy- matous medium echo in the adrenal glands, uneven internal echo and visible punetiform blood stream reflex. CT all indica- ted the unsharp edge, CT value as 32-65 HU and uneven enhancement. MRI showed vague boundary, 2 cases of hyperin- tense and 1 case of low-high signal on T2 weighted images, and it also showed necrotic areas of lesion center were not signif- icant enhanced. Five cases underwent open operation to completely remove the tumor. After surgery, 2 cases was treated by mitotane and 1 case received radiotherapy. They were followed up for 6-36 months, and the mean survival time was 23 months. Conclusion Type-B ultrasonic, CT and other tests can help the early diagnosis of ACC. Surgery is considered to be the effective way to cure ACC.