肾上腺平滑肌瘤1例报告并文献复习

Adrenal leiomyoma:a case report and literature review

目的探讨肾上腺平滑肌瘤的临床特征及诊治方法。方法介绍我院诊治的1例肾上腺平滑肌瘤患者的临床资料,并统计有关文献,探讨其临床特征及诊治方法。结果本例与相关文献报道的44例共45例患者纳入研究,其中男性19例,女性26例,发病年龄2~72岁,平均37.8岁。9例患者人类免疫缺陷病毒(human immunodeficiency virus,HIV)阳性,7例患者EB病毒阳性,其中2例HIV和EB均为阳性。肾上腺平滑肌瘤多数无临床症状或体征,64%(29/45)为影像学检查意外发现,33%(15/45)因腹痛、腹胀或腰痛等症状就诊检查发现,1例因腹部无痛性包块就诊发现。多数肾上腺平滑肌瘤无激素分泌功能。45例确诊病例中,1例经穿刺明确(未行手术),1例经尸检发现,其余病例经肾上腺肿瘤切除术后病理明确。部分病理伴有钙化、囊变或坏死等。7例患者经保守观察4个月~4年,肿瘤均明显增大。肿瘤切除病例中有随访数据者19例,均无瘤生存,未见复发。结论肾上腺平滑肌瘤临床罕见,没有特异的临床或影像学特征,也没有特异的生物标志物,术前确诊困难,保守观察肿瘤增大,建议手术切除,确诊有赖于术后病检,肿瘤完整切除后不易复发。

Objective To investigate the diagnosis and clinical managements of adrenal leiomyoma.Methods A retrospective analysis was conducted on the clinical data of a patient with adrenal leiomyoma and 44 patients from relevant literature to explore its clinical characteristics a nd diagnosis and treatment methods.Results It was enrolled of a total of 45 patients,including 19 males and 26 females,with onset ages ranging from 2 to 72 years(averaged 37.8 years)in whom 9 HIV positive,7 EB virus positive,with 2 of them both HIV and EB positive.Most of adrenal leiomyomas had no clinical symptoms or signs.64%(29/45)was found by imaging examination serendipitously,and 33%(15/45)was found by medical examination due to abdominal pain,abdominal distention or low back pain.Most adrenal leiomyomas had no hormone secretion function.Among the 45 confirmed cases,1 case was confirmed by puncture without surgery,1 case was found at autopsy,and the remaining cases were pathologically confirmed after adrenal tumor resection.Some pathological changes were accompanied by calcification,cystic change or necrosis.After conservative observation for 4 months to 4 years,all 7 patients showed significant tumor enlargement.None of the tumor resection cases with follow-up data showed recurrence.Conclusions Adrenal leiomyoma is rare in clinical practice.It has little specific clinical or imaging features,specific biomarkers,and is difficult to diagnose before surgery.Tumor enlargement during conservative observation suggests the necessity of surgical resection.Diagnosis depends on postoperative pathological examination,and no recurrence is observed after complete tumor resection.