原发性肾上腺皮质腺癌的CT表现与病理特点
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摘要
目的:分析原发性肾上腺皮质腺癌(ACC)的CT表现与病理特点,以提高诊断的准确性。方法:回顾性分析经手术与病理证实的16例ACC的CT图像特点、临床资料及病理学特点。结果:功能性ACC6例,无功能性ACC 10例;16例ACC中,位于左侧肾上腺7例,右侧9例,大小4.4cm×5.4cm～14cm×17cm,最小直径<5cm3例;CT平扫表现为分叶状或不规则7例,类圆形3例,椭圆形6例;边界模糊9例,边界较清7例;内见点状或条状钙化5例;病灶内坏死形态不规则15例。16例ACC增强后全部表现为不均匀强化,坏死边缘显示较模糊。其中6例ACC中央出现星芒状、裂隙状较宽区域坏死;2例肿瘤实质大部分坏死形成假囊肿样。病理上肿瘤血管丰富,多见广泛出血、坏死,有血管包膜浸润。结论:ACC的CT表现具有一定的特征性,与其病理改变有一定的关系。掌握这些有助于提高诊断正确率。
Purpose: To analyze the CT characteristics and pathological features of primary adrenocortical carcinoma(ACC), to improve the diagnostic accuracy of it.Methods: The CT manifestations, clinical information and pathological features of 16 ACC cases proved by surgery and pathology results were analyzed retrospectively.Results: There were 6 functional tumors and 10 non-functional masses. Seven of 16 lesions were located in the left adrenal gland, 9 in the right. The size of the tumors was ranged 4.4 cm×5.4 cm-14 cm×17 cm, 3 lesions were with diameter less than 5.0 cm. On plain CT: 7 lesions were lobulated or irregular, 3 lesions were round, 6 lesions were oval-shaped; 9 lesions were ill-defined and 7 cases were well defined; 5 lesions showed with spot or strip-like calcification; 15 cases were with necrosis; All 16 cases were inhomogeneous enhanced after contrast administration,and 2 cases with necrosis showed pseudocyst-like feature. The pathological result showed that all tumors were with illustrated confluent blood vessels, with hemorrhage and necrosis. The membrane of the vessels were infiltrated.Conclusion: The CT manifestations of adrenocortical carcinoma are characteristic, they have certain relationship with the pathological changes. Familiar with these will improve their diagnostic accuracy..
Purpose: To analyze the CT characteristics and pathological features of primary adrenocortical carcinoma(ACC), to improve the diagnostic accuracy of it.Methods: The CT manifestations, clinical information and pathological features of 16 ACC cases proved by surgery and pathology results were analyzed retrospectively.Results: There were 6 functional tumors and 10 non-functional masses. Seven of 16 lesions were located in the left adrenal gland, 9 in the right. The size of the tumors was ranged 4.4 cm×5.4 cm-14 cm×17 cm, 3 lesions were with diameter less than 5.0 cm. On plain CT: 7 lesions were lobulated or irregular, 3 lesions were round, 6 lesions were oval-shaped; 9 lesions were ill-defined and 7 cases were well defined; 5 lesions showed with spot or strip-like calcification; 15 cases were with necrosis; All 16 cases were inhomogeneous enhanced after contrast administration,and 2 cases with necrosis showed pseudocyst-like feature. The pathological result showed that all tumors were with illustrated confluent blood vessels, with hemorrhage and necrosis. The membrane of the vessels were infiltrated.Conclusion: The CT manifestations of adrenocortical carcinoma are characteristic, they have certain relationship with the pathological changes. Familiar with these will improve their diagnostic accuracy..
引文
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[6]田伟,肖剑秋,胡荣慧,等.原发性肾上腺皮质腺癌的CT诊断.中华放射学杂志,1999,31:625-627。
[7]Ribeiro J,Ribeiro RC,Fletcher BD.Imaging findings in pediatric adrenocortical carcinoma.Pediatr Radiol,2000,30:45-51.
[8]汪建华,丁前江,马小龙.肾上腺原发性皮质腺癌的CT与MR表现及其病理基础.中华放射学杂志,2016,50:882-885。
[9]Vierhapper H,Heinze G,Gessl A,et al.Adrenocortical tumors;prevalence ofimpaired glucose tolerance and of‘paradoxical Rise’of cortisol during and oral glucose tolerance test.Exp Clin Endo Diab,2003,111:415-420.
[10]刘衡,黄可忻,柏永华.肾上腺恶性肿瘤的CT,MRI表现及其病理学基础.实用放射学杂志,2016,32:1077-1080。
[11]周銮,孙华平,施振威,等.肾上腺非霍奇金淋巴瘤的CT表现.中国医学计算机成像杂志,2012,18:144-146。
[2]Aasaki K,Desimone M,Rao HR,et al,Adrenocortical carcinosarcoma:a case report and review of the literature.Diagn Pathol,2010,5:51.
[3]Bharwani N,Rockall AG,Sahdev A,et al.Adrenocortical Carcinoma:the range of appearances on CT and MRI.AJR,2011,196:W706-714.
[4]Kashiwagi S,Amano R,Onoda N,et al,Nonfunctional adrenocortical carcinoma initially presenting sunnal masses.AJR,2006,187:191-196.
[5]Johnson PT,Horton KM,Fishman EK.Adrenal mass imaging with multidetector CT:pathologic conditions,pearls,and pitfalls.Radiographics,2009,29:1333-1351.
[6]田伟,肖剑秋,胡荣慧,等.原发性肾上腺皮质腺癌的CT诊断.中华放射学杂志,1999,31:625-627。
[7]Ribeiro J,Ribeiro RC,Fletcher BD.Imaging findings in pediatric adrenocortical carcinoma.Pediatr Radiol,2000,30:45-51.
[8]汪建华,丁前江,马小龙.肾上腺原发性皮质腺癌的CT与MR表现及其病理基础.中华放射学杂志,2016,50:882-885。
[9]Vierhapper H,Heinze G,Gessl A,et al.Adrenocortical tumors;prevalence ofimpaired glucose tolerance and of‘paradoxical Rise’of cortisol during and oral glucose tolerance test.Exp Clin Endo Diab,2003,111:415-420.
[10]刘衡,黄可忻,柏永华.肾上腺恶性肿瘤的CT,MRI表现及其病理学基础.实用放射学杂志,2016,32:1077-1080。
[11]周銮,孙华平,施振威,等.肾上腺非霍奇金淋巴瘤的CT表现.中国医学计算机成像杂志,2012,18:144-146。