肾上腺海绵状血管瘤临床及影像特征  

Clinical and imaging features of adrenal cavernous hemangioma

作　　者：宋钰峰 宁豪[1,2] 姚志刚 吴海虎 刘非凡[1] 吕家驹 SONG Yufeng;NING Hao;YAO Zhigang;WU Haihu;LIU Feifan;LYU Jiaju(Department of Urology,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250021,Shandong,China;Department of Urology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China;Department of Pathology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China)

机构地区：[1]山东大学附属省立医院泌尿外科,山东济南250021 [2]山东第一医科大学附属省立医院泌尿外科,山东济南250021 [3]山东第一医科大学附属省立医院病理科,山东济南250021

出　　处：《山东大学学报（医学版）》2022年第2期37-42,共6页Journal of Shandong University:Health Sciences

摘　　要：目的分析肾上腺海绵状血管瘤(ACH)的临床及影像资料,总结该疾病特征与诊治经验。方法收集2011年1月至2021年7月收治的6例经术后病理证实的ACH的临床及影像资料,回顾性总结分析,并进行相关文献复习。结果6例患者平均56.8岁(33~69岁)。4例患者为查体发现,2例分别因高血压与腹部不适就诊。血压升高者4例,其中2例有阵发性血压波动史。术前仅1例行MRI增强扫描后诊断为血管瘤,其他术前诊断包括嗜铬细胞瘤2例、囊肿2例、腺瘤1例。肿瘤平均最大径4.2 cm(2.0~7.1 cm)。全部患者均行腹腔镜患侧肾上腺切除术,术后中位随访时间13.5个月(4~130个月),肿瘤无复发,仅2例阵发性血压波动病史的患者术后高血压明显缓解。结论ACH为罕见的肾上腺良性肿瘤,临床症状隐匿,部分患者可有腹部不适和阵发性血压波动。影像学延迟不均匀向心性强化可视为其特征表现,平扫点状钙化、边缘结节状强化可辅助诊断。体积较大的ACH需要与嗜铬细胞瘤相鉴别,增强扫描中对比剂充填速度可作为重要鉴别点。CT与MRI技术相结合,可提高其诊断准确率。腹腔镜手术切除是首选的治疗方式。Objective To analyze the clinical and imaging data of adrenal cavernous hemangioma(ACH),and to summarize the characteristics,diagnosis and treatment experience of the disease.Methods The clinical and imaging data of 6 cases of ACH confirmed by postoperative pathology during Jan.2011 and Jul.2021 were retrospectively analyzed,and relevant literatures were reviewed.Results The average age of the patients was 56.8 years(33-69 years).Adrenal tumor was detected in 4 cases during physical examination,and in 2 cases due to hypertension or abdominal discomfort.Blood pressure increased in 4 cases,2 of which had a history of paroxysmal blood pressure fluctuation.Preoperative MRI enhanced scan was performed in 1 case,which was then diagnosed as hemangioma,and the other preoperative diagnoses included pheochromocytoma(n=2),cyst(n=2)and adenoma(n=1).The average maximum diameter of tumor was 4.2 cm(2.0-7.1 cm).All patients underwent laparoscopic unilateral adrenalectomy.During the median follow-up of 13.5 months(4-130 months),no tumor recurrence was observed,and the 2 patients with a history of paroxysmal blood pressure fluctuation had significant remission.Conclusion ACH is a rare benign adrenal tumor with hidden clinical symptoms,and some patients may have abdominal discomfort and paroxysmal blood pressure fluctuation.The imaging characteristic is delayed inhomogeneous centripetal enhancement,and plain scan with point calcification and edge nodular enhancement can assist the diagnosis.Large-volume ACH needs to be differentiated from pheochromocytoma.The filling speed of contrast medium in enhanced scanning can be used as an important identification point.The combination of CT and MRI can improve the diagnostic accuracy.Laparoscopic surgery is the preferred treatment.

关 键 词：肾上腺肿瘤 肾上腺海绵状血管瘤 高血压 影像 诊断 治疗 

分 类 号：R736.6[医药卫生—肿瘤]