肾上腺肿瘤和瘤样病变1166例病理分析

Pathologically Analyzing 1166 Cases of Adrenal Tumors and Tumor-like Lesions.

目的:研究肾上腺手术标本的组织学类型和病理诊断的主要问题。方法:收集本科1980～2002年间全部肾上腺手术标本,根据世界卫生组织(WHO)内分泌肿瘤组织学分类(1999)标准进行病理分析。结果:肾上腺病变共1166例,其中肿瘤913例(78.3%),非肿瘤性病变253例(21.7%)。肿瘤中良性881例(96.5%),恶性32例(3.5%)。占良性肿瘤前三位的依次是肾上腺皮质腺瘤634例(72.0%)、嗜铬细胞瘤196例(22.2%)和髓性脂肪瘤30例(3.4%);恶性肿瘤32例中肾上腺皮质癌22例(68.8%),恶性嗜铬细胞瘤5例(15.6%)。非肿瘤性病变中肾上腺皮质增生206例(81.4%),皮质萎缩13例(5.1%);原发性色素性结节状肾上腺皮质病7例(2.8%)。肾上腺髓质增生8例(3.2%)。结论:①肾上腺病变占送检标本的0.32%,其发生率近年来呈上升趋势。②肾上腺皮质病变的主要组织学类型为皮质腺瘤和皮质增生。③髓质病变中93.8%为嗜铬细胞瘤。④肾上腺间质病变以髓性脂肪瘤最常见。⑤肾上腺恶性肿瘤非常少见,主要为皮质癌。因此,外科病理中的主要问题是皮质腺瘤与皮质结节状增生的鉴别,皮质癌的诊断应参照Weiss组织学标准。

Objective:To study the histological types o f adrenal gland tumors and tumor-like lesions and the main problems on patholog ical diagnosis.Methods:All surgical specimens of adrenal glands obtained from198 0to2002were collected and classified according to the morphologic criteria of Wo rld Health Organization(WHO)Histological Classification of Endocrine Tumor.Resul ts:There were1166cases of adrenal tumor and tumor-like lesions.Among them there were913(78.3%)cases of different types of tumor,included881cases of benign and3 2cases of malignant tumor,and253(21.7%)cases of tumor-like lesion.The first thr ee histological types of benign tumor were adrenocortical adenoma(634cases,72.0% ),pheochromocytoma(196cases,22.2%),and myelolipoma(30cases,3.4%),respectively.Th e majority of malignant adrenal tumor were adrenocortical carcinoma(22cases,68.8 %)and malignant pheochromocytoma(5cases,15.6%).There were206(81.4%)patients with adrenocortical hyperplasia,13cases(5.1%)of adrenal atrophy,7cases(2.8%)of prima ry pigmented adrenocortical nodular disease,and8cases(3.2%)of medulla hyperplasi a among tumor-like lesions.Conclusions:①The adrenal specimens accounted for0.3 2%of total surgical samples during the same period and the proportion of adrenal specimens has been increased in recent years.②The commonest histological type among adrenocortcal lesions is adrenocortical adenoma(54.4%)and the hyperplasia of adrenal cortex(17.67%).③Pheochromocytoma is the commonest type of medulla le sion.④Myeolipoma is the commonest of adrenal stroma.⑤The critical problems for the surgical pathology are,therefore,to make differential diagnosis between ade noma and nodular hyperplasia of adrenal cortex and discern the malignancy of adr enocortical carcinoma depending on Weiss'histologic diagnostic criteria.