巨大肾上腺肿瘤2例诊治分析

Analysis of two cases of huge adrenal tumor

目的探讨肾上腺巨大肿瘤的临床表现及诊治方法。方法回顾性分析2013年9月至2015年1月威海市中心医院收治的2例肾上腺肿瘤直径超过10 cm的患者的相关资料,对其临床表现、诊治方法及预后进行分析,并查阅国内外文献资料。结果 2例患者术前均疑诊为肾上腺皮质癌。病例1:女性,28岁,行腹腔镜左肾上腺肿瘤切除术,因术中肿瘤破裂、出血而中转开放手术姑息性切除肿瘤,术后病例示肾上腺皮质癌,术后10个月患者死于肿瘤转移导致的消化道大出血;病例2:女性,39岁,行腹腔镜左肾上腺肿瘤切除术,术中完整切除肿瘤,术后病理示具有恶性潜能的肾上腺皮质肿瘤,术后随访15个月,未见肿瘤复发。结论对于直径大于10 cm的肾上腺肿瘤,如果术前诊断倾向于恶性肿瘤,则手术方式宜选择开放术式;巨大肾上腺皮质癌治疗效果较差,应采取手术和化疗等相结合的综合治疗以改善预后。

Objective To investigate the clinicopathological characteristics, diagnosis and treatment of huge adrenal tumor. Methods Retrospectively analysed the clinical data of the 2 patients with huge adrenal tumor more than 10 cm in diameter, who were admitted in our hospital from September 2013 to January 2015. Clinical manifestations, treatment and prognosis were evaluated. Results Two patients were both suspected of adrenocortical carcinomas. Case 1 was a 28-year-old female. Laparoscopic surgery was performed at first but was conversed to open palliative adrenalectomy due to tumor rupture and bleeding. The postoperative pathology was adrenocortical carcinoma. The patient died of gastrointestinal bleeding caused by tumor metastasis 10 months later. Case 2 was a 39-year-old female, who underwent laparoscopic adrenolectomy with tumor excision completely. The postoperative pathology showed neoplasm of malignant potential, and no tumor recurred in 15 months follow-up. Conclusions Open surgery should be the priority if the diameter of adrenal tumor is more than 10 cm and diagnosis as suspicious of malignancy. Huge adrenocortical carcinoma is related to poor therapeutic response, and muhimodality therapy may improve the prognosis.