肾脏异位肾上腺皮质腺瘤1例报告并文献复习

Renal ectopic adrenocortical adenoma:a case report and literature review

目的:提高对肾脏异位肾上腺皮质腺瘤的认识和诊疗能力。方法:对收治的1例肾脏异位肾上腺皮质腺瘤患者的诊治经过进行回顾性分析,总结临床经验,并结合文献进行复习归纳,分析术前误诊原因。结果:患者因“恶心、纳差4 d”入院,术前影像学检查提示肾上腺占位,血醛固酮升高,血钾降低,考虑肾上腺醛固酮瘤,术中见肿瘤来源肾脏上极,与肾上腺分界清楚,行3D腹腔镜右肾部分切除手术,术后病理报告(右肾肿物)皮质腺瘤。经过4个月的术后随访,患者血醛固酮、血钾恢复正常,无并发症。结论:肾脏异位肾上腺皮质腺瘤罕见,最终需要手术及病理确诊。肾脏上极异位肾上腺肿瘤或增生,容易误诊,发现后应进行手术确诊,尽可能采用肾部分切除术。

Objective To improve the diagnosis and treatment of renal ectopic adrenocortical adenoma.Methods A case of renal ectopic adrenocortical adenoma was retrospectively analyzed,clinical experience was summarized,and the causes of preoperative misdiagnosis were analyzed by reviewing and summarizing the literature.Results The patient was admitted to the hospital due to nausea and poor toleration for 4 days.Preoperative imaging examination indicated adrenal space occupation.Elevated blood aldosterone and decreased blood potassium were also found.Thus,adrenal aldosteronoma was considered.Intraoperatively,the tumor was found to be from the upper pole of the kidney and clearly demarcated from the adrenal gland.Laparoscopic right partial nephrectomy was performed,then postoperative pathologic diagnosis was cortical adenoma in the right kidney.After 4 months of postoperative follow-up,the patient's aldosterone and potassium returned to normal without complications.Conclusion Renal ectopic adrenocortical adenoma is rare and needs to be confirmed by surgery and pathology.Ectopic adrenal tumor or hyperplasia in the upper pole of the kidney is easy to be misdiagnosed,so surgery should be performed to confirm the diagnosis.Partial nephrectomy should be used as far as possible.