腹膜后副神经节瘤误诊为肾上腺区脓肿临床报告并文献复习

A Case Report and Literature Review of Retroperitoneal Paraganglioma Misdiagnosed as Periadrenal Abscess

目的总结腹膜后副神经节瘤临床特点和诊治要点,探讨误诊原因及防范措施。方法回顾性分析1例误诊为肾上腺区脓肿的腹膜后副神经节瘤临床资料。结果本例因反复胸痛10 d,咳嗽、咳痰3 d,胸痛再发6 h入院。入院后完善心肌酶谱、肝肾功能、腹部增强CT及内分泌功能检查,诊断为右肾上腺区脓肿,行脓肿切开引流术。术中切开肿物时血压剧烈波动,术中冷冻病理检查考虑肾上腺实质来源肿瘤,行右肾上腺区肿物切除术,术后病理检查诊断为腹膜后副神经节瘤。术后2周行内分泌功能检查未见异常,行PET-CT检查未见其他部位转移灶。随访1年,定期复查上腹部超声未见肿瘤复发。结论腹膜后副神经节瘤是一种少见神经内分泌肿瘤,术前易误诊。临床上对类似本文患者手术探查时若患者血压剧烈波动应考虑到副神经节瘤,要及时行冷冻病理检查以确诊。

Objective To summarize clinical features and diagnostic key points of retroperitoneal paraganglioma in order to discuss misdiagnosed causes and preventive measures.Methods Clinical data of a patient with retroperitoneal paraganglioma, who was misdiagnosed as having periadrenal abscess, was retrospectively analyzed.Results The patient was admitted for repeated chest pain for 10 d, cough, expectoration for 3d and recurrence of chest pain for 6h.After admission, myocardial enzymes, liver and kidney function, abdominal enhanced CT and endocrine function examinations were performed, and the right periadrenal abscess was diagnosed, and then surgical incision and drainage were given.Severe fluctuation of blood pressure during intraoperative period was found, and adrenal tumor was suspected by intraoperative frozen section diagnosis, and then tumor exsection of right adrenal gland was performed.Retroperitoneal paraganglioma was diagnosed by postoperative pathological examination.In postoperative 2 weeks, result of endocrine function test was normal, and PET-CT test showed no metastases.With 1 year of follow-up, no recurrence was found by regular abdominal ultrasound examination.Conclusion The retroperitoneal paraganglioma is a rare neuroendocrine tumor, and it is easily misdiagnosed before operation.Patients with obvious fluctuation of blood pressure during surgical exploration should be suspected as having paraganglioma, and clinicians should given frozen section in time to confirm the diagnosis.