肾上腺皮质嗜酸细胞腺瘤的临床病理特征和腹腔镜手术

Clinicopathological Features and Minimal Invasive Management of Oncocytic Adrenal Neoplasm

目的探讨肾上腺皮质嗜酸细胞腺瘤的临床病理特征及微创治疗效果。方法回顾性分析2005年1月～2017年2月肾上腺皮质嗜酸细胞腺瘤4例的临床资料,并进行相关文献复习。女2例,男2例,年龄15～59岁,平均42岁。2例女性表现为男性化,均有多次自然流产史。2例腰背部疼痛。术前CT均提示肾上腺肿瘤,4例均行后腹腔镜肾上腺肿瘤切除术。结果均手术顺利,术后病理测量肿瘤直径3.0～9.0 cm,(5.10±2.76)cm。病理均提示肾上腺皮质嗜酸细胞腺瘤:肿瘤组织嗜酸性明显,大部分区域肿瘤细胞弥漫分布,未见明确核分裂象。均未见出血、坏死、包膜或血管受侵犯。术后随访9～60个月,平均44个月,未见复发。结论肾上腺皮质嗜酸细胞腺瘤体积多较大,绝大多数临床表现多样复杂,极易与其他肾上腺肿瘤混淆,病理方能确诊,微创手术治疗预后较好。

Objective To explore the clinicopathological characteristics,diagnosis and treatment of oncocytic adrenal neoplasm（ OAN）. Methods A retrospective analysis was made on 4 cases of OAN from January 2005 to February 2017 in our hospital,including 2 females and 2 males,at the mean age of 42（ 15-59） years old. Among them,2 cases of female patients showed masculine and irregular menstruation,combined with repeated abortion. Two cases had pains in lumbar and back. The CT showed adrenal adenomas. All the patients underwent laparoscopic operations. Results All the operations were completed successfully. The diameter of the tumor was（ 5. 10 ± 2. 76） cm（ range,3. 0-9. 0 cm） after postoperative pathology. The pathological findings were OAN. The acidophilic tissue was obvious. The most of the tumor cells were distributed diffusely,without clear mitotic image. No bleeding,necrosis,or capsular and vascular invasion was found. The patients were followed up for 9-60 months with an average of 44 months without recurrence. Conclusions OAN is a kind of large volume tumor,with various and complex clinical manifestations and being easily confused with other adrenal tumors. The minimally invasive treatment has good prognosis.