原发性双侧肾上腺大结节增生合并肾细胞癌3例临床分析

Synchronous primary bilateral macronodular adrenal hyperplasia with renal cell carcinoma:a case series of three patients

分析3例原发性双侧肾上腺大结节增生(PBMAH)合并肾细胞癌患者的临床特征、影像学表现、治疗方式和病理学特点。PBMAH合并肾细胞癌罕见,两者有无内在关联尚需进一步探索;其中肾细胞癌容易漏诊,诊治双侧肾上腺病变时,需要高度关注影像学上双侧肾脏有无可疑的病灶是关键点。双侧肾上腺结节性增生首选腹腔镜肾上腺切除术,肾细胞癌根据肿瘤大小及部位选择腹腔镜肾部分切除或根治性肾切除术。PBMAH患者双侧肾上腺术后需密切随访,以免肾细胞癌的延误诊治。

Three cases of synchronous primary bilateral macronodular adrenal hyperplasia(PBMAH)and renal cell carcinoma(RCC)in the Department of Urology of Peking Union Medical College Hospital were retrospectively reviewed.The clinical features,imaging features,treatment methods and pathological features of these patients were analyzed.It was found that the genetic relationship between synchronous PBMAH and RCC needs further research.And RCC is easy to be misdiagnosed.We should pay high attention to imaging features to find out whether there are lesions in bilateral kidneys when we deal with bilateral adrenal lesions.Laparoscopic approach is recommended for PBMAH and RCC.Total or partial nephrectomy should be performed according the tumor size and location of the renal mass.Patients with PBMAH should be closely followed up after bilateral adrenalectomy to avoid delay in diagnosis or treatment of RCC.