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題名 | Adrenal Hemangioma: Two Cases Report=腎上腺血管瘤:二例報告 |
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作者 | 戴順慶; 陳孝文; 朱聖賢; Tay, Soon-kheng; Chen, Hsiao-wen; Chu, Sheng-hsien; |
期刊 | 長庚醫學 |
出版日期 | 19980600 |
卷期 | 21:2 1998.06[民87.06] |
頁次 | 頁195-199 |
分類號 | 416.273 |
語文 | eng |
關鍵詞 | 腎上腺; 血管瘤; Adrenal gland; Hemangioma; |
中文摘要 | 腎上腺血管瘤是罕見、無功能性之良性腫瘤。病變界限清楚且不會有正常血管侵 襲周圍組織的現象。在顯微鏡下,可清楚看到無數不同口徑血液竇狀隙,且有單層扁平內皮 細胞襯裡。最常見的發生部位為皮膚和肝臟。腎上腺血管瘤多半沒有臨床狀況,因此多在屍 體解剖之際偶然被發現。不過值得提的1例具有內分泌功能腎上腺血管瘤分泌過多皮質素引 起高血壓、血清鉀降低及血清納升高之現象。最後經由外科切除此腫瘤而獲痊癒。除此之外, 腎上腺血管瘤偶而可大到某種程度造成鄰近器官(如胃、十二指腸、大腸等)之壓迫而產生 症狀,因此有近8成病人可由其他專科意外發現轉診而來。至今英文文獻上約有14個病例 報告。好發年齡層從37至74歲皆有,但大部份集中於60至70歲間。此良性腎上腺瘤屬女 性較多,比男性多了一倍。多數單側,也有2例雙側同時發生的報告。本文報告2例腎上腺 血管瘤都是在非泌尿科主訴之下意外發現。第1例病患主訴腹部膨脹感而經由腸胃科腹部超 音波意外發現腎上腺血管瘤壓迫所造成。第2例主訴一段時間之腰酸背痛,在復健科脊椎X 光片及電腦斷層攝影意外發現。之後經由外科切除且術後確實診斷為腎上腺血管瘤。術前X 光片檢查及電腦斷層攝影之特殊靜脈石樣環狀鈣化為腎上腺血管瘤攝影上之典型特徵。但是 從文獻上追溯到唯一1例報告記載著腎上腺血管瘤在X光上的典型環狀鈣化特徵。本文章所 報告2例具有X光上的典型環狀鈣化,但是卻未能及時做正確術前診斷。腎上腺腫瘤的一般 鈣化可見於惡性腫瘤(carcinoma)、囊腫(cysts)、親鉻細胞瘤(pheochronocytoma)、畸胎 瘤(teratoma)、良性腺瘤(adenoma)等等。因此,我們認為腎上腺血管瘤之術前診斷不易, 須列入腎上腺惡性瘤之鑑別診斷之一。不過,必須強調的是,如果術前檢查無法區分良性或 惡性,除非術前或術中施行切片檢查確定良性,否則一律當惡性腫瘤論以外科切除。 |
英文摘要 | Adrenal hemangiomas are rare, nonfunctioning benign tumors. They are well circumscribed and comprise of closely adjacent vascular channels of varying sizes that are lined with a single layer of endothelium. When they occur, they are frequently located in the skin and liver. There are no characteristic symptoms of adrenal hemangioma unless the tumor reaches a size large enough to exert pressure. To our knowledge, there have been 14 clinical cases of adrenal hemangiomas reported, all with similar pathologic pathologic features. We present 2 additional cases, which were identified incidentally after non-urologic complaints (epigastric fullness and low back pain in patient 1 and patient 2, respectively). In these 2 patients, the tumors were surgically removed and diagnosed postoperatively as adrenal hemangiomas. Preoperative radiologic findings on plain film and abdominal computerized tomography showed the characteristic round calcifications with translucent centers, typical of phleboliths, to be pathognomonic of adrenal gland hemangiomas. Unfortunately, this characteristic feature of adrenal hemangioma existed in only one case report. In conclusion, the preoperative diagnosis of adrenal hemangioma is difficult but should be kept in mind as being pat of the differential diagnosis of adrenal tumors. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。