肾上腺皮质癌1例报道并文献回顾

Adrenocortical carcinoma:One case report and literature review

目的:探讨肾上腺皮质癌的临床表现、诊断及治疗方法。方法:报道我科近期收治的1例肾上腺皮质癌患者的临床资料,并检索中国知网、PubMed等数据库,进行文献回顾,对该病的临床特征及诊断要点、治疗方法及最新的研究进展进行归纳总结。结果:本例患者以腹痛为首发临床表现,影像学提示肾上腺肿瘤,行腹腔镜切除,术后20天查PET/CT提示多发转移,给予依托泊苷+顺铂化疗4周期后进展,遂应用吉西他滨联合卡培他滨化疗1周期,出现脑转移后行放疗。结论:肾上腺皮质癌是一种罕见的泌尿系恶性肿瘤,且预后差。诊断应结合临床表现、肾上腺皮质激素水平、影像学检查及病理结果。治疗方面首推多学科会诊(MDT),早期患者首选手术,术后需根据疾病分期、分级选择辅助治疗,复发转移的患者可给予化疗、放疗、米托坦、免疫治疗等。

Objective:To discuss the clinical characteristics,diagnosis and treatment methods of adrenocortical carcinoma.Methods:This article reported the clinical data of a patient with adrenocortical carcinoma admitted to our department recently,and databases such as CNKI and PubMed were searched for literature review to summarize the clinical characteristics,diagnosis points,treatment methods and the latest research progress of this disease.Results:In this case,abdominal pain was the first clinical symptom.Imaging examination revealed adrenal tumor,and laparoscopic resection was performed.PET/CT showed multiple metastases 20 days after the operation.The disease progressed after 4 cycles of chemotherapy with etoposide+cisplatin.After 1 cycle of chemotherapy with gemcitabine+capecitabine,brain metastasis occurred.Then the patient received radiotherapy for brain metastases.Conclusion:Adrenocortical carcinoma is a rare malignant tumor with poor prognosis.The diagnosis should be combined with clinical features,adrenocortical hormone level,imaging and pathological results.In terms of treatment,MDT is the first choice.Surgery is the first choice for patients in the early stage.After the operation,adjuvant treatment should be selected according to the stage and grade of the disease.Patients with recurrence and metastasis can be given chemotherapy,radiotherapy,mitotane,immunotherapy,and so on.