A 5-year-old boy presented with headache and hypertension. Screening abdominal ultrasonography showed a 6-cm-sized mass in the left adrenal gland. Laboratory data included urine vanillylmandelic acid/creatinine (208.3...A 5-year-old boy presented with headache and hypertension. Screening abdominal ultrasonography showed a 6-cm-sized mass in the left adrenal gland. Laboratory data included urine vanillylmandelic acid/creatinine (208.3 μ g/mg),urine homovanillic acid/creatinine (114.3 μ g/mg),serum epinephrine (237 pg/mL),and serum norepinephrine (1842 pg/mL)-. Metaiodobenzyl guanidine I 123 scintigram,abdominal computed tomography,and abdominal magnetic resonance imaging revealed only left adrenal tumor with no metastasis. Left adrenalectomy was performed transperitoneally,and histopathological diagnosis was an adrenal composite pheochromocytoma associated with neuroblastoma. Immunoreactivity for vimentin was positive in pheochromocytoma,which was negative in neuroblastoma. After operation,the symptom of hypertension disappeared. We should examine the identification of composite pheochromocytoma by immunohistochemistry method in patients with neuroblastomatous elements complicated by severe hypertension,and it is important to carefully monitor urine vanillylmandelic acid and urine homovanillic acid in the examination tests and hypertension in the clinical symptoms,and follow up this patient because of some risk of recurrence and metastasis.展开更多
患者女,40岁,因“阵发性腰背部酸痛2月余”于2014年3月18日入院。既往无高血压等疾病史。腹部 B 超：右侧肾上腺部位见一无回声区,大小约6.4 cm ×5.0 cm ×1.5 cm,其内未见血流信号（图1A）,考虑肾上腺囊肿可能。腹部 CT平扫...患者女,40岁,因“阵发性腰背部酸痛2月余”于2014年3月18日入院。既往无高血压等疾病史。腹部 B 超：右侧肾上腺部位见一无回声区,大小约6.4 cm ×5.0 cm ×1.5 cm,其内未见血流信号（图1A）,考虑肾上腺囊肿可能。腹部 CT平扫可见右侧腹膜后一不规则囊性低密度影,CT 值10 HU,边界清楚,大小约6.8 cm ×5.3 cm ×1.7 cm；增强后未见明显强化（图1B、1C）。拟诊右侧腹膜后淋巴管瘤。术前血、尿、粪常规、血液生化、血电解质以及肾上腺全套（肾上腺素、血浆醛固酮、血浆皮质醇、血浆儿茶酚胺）、尿香草扁桃酸均未见异常。展开更多
文摘A 5-year-old boy presented with headache and hypertension. Screening abdominal ultrasonography showed a 6-cm-sized mass in the left adrenal gland. Laboratory data included urine vanillylmandelic acid/creatinine (208.3 μ g/mg),urine homovanillic acid/creatinine (114.3 μ g/mg),serum epinephrine (237 pg/mL),and serum norepinephrine (1842 pg/mL)-. Metaiodobenzyl guanidine I 123 scintigram,abdominal computed tomography,and abdominal magnetic resonance imaging revealed only left adrenal tumor with no metastasis. Left adrenalectomy was performed transperitoneally,and histopathological diagnosis was an adrenal composite pheochromocytoma associated with neuroblastoma. Immunoreactivity for vimentin was positive in pheochromocytoma,which was negative in neuroblastoma. After operation,the symptom of hypertension disappeared. We should examine the identification of composite pheochromocytoma by immunohistochemistry method in patients with neuroblastomatous elements complicated by severe hypertension,and it is important to carefully monitor urine vanillylmandelic acid and urine homovanillic acid in the examination tests and hypertension in the clinical symptoms,and follow up this patient because of some risk of recurrence and metastasis.
文摘患者女,40岁,因“阵发性腰背部酸痛2月余”于2014年3月18日入院。既往无高血压等疾病史。腹部 B 超：右侧肾上腺部位见一无回声区,大小约6.4 cm ×5.0 cm ×1.5 cm,其内未见血流信号（图1A）,考虑肾上腺囊肿可能。腹部 CT平扫可见右侧腹膜后一不规则囊性低密度影,CT 值10 HU,边界清楚,大小约6.8 cm ×5.3 cm ×1.7 cm；增强后未见明显强化（图1B、1C）。拟诊右侧腹膜后淋巴管瘤。术前血、尿、粪常规、血液生化、血电解质以及肾上腺全套（肾上腺素、血浆醛固酮、血浆皮质醇、血浆儿茶酚胺）、尿香草扁桃酸均未见异常。
