腎上腺之髓脂瘤－病例報告

Myelolipoma of the Adrenal Gland - A Case Report

方俊慧(Tsin Hui Fang) ； 吳誠中(Cheng-Chung Wu) ； 陳振鵬(Jenn-Perng Chen) ； 吳天成(Tain-Cheng Wu) ； 劉自嘉(Tse-Jia Liu)

《The Kaohsiung Journal of Medical Sciences》 3卷12期 (1987/12) Pp. 783-787

https://doi.org/10.6452/KJMS.198712.0783

摘要

髓脂瘤是腎上腺一種很少見，無功能良性腫瘤，由成熟的脂肪組織及造血組織所構成。在一個有膽囊結石的婦人身上，我們同時發現右側腎上腺有一腫瘤，超音波檢查顯示一個高回音質的腫瘤，電腦斷層顯示出其含有脂肪，血管攝影為一個無血管性的腫瘤。在施行膽囊切除手術時，我們同時切除了此一腫瘤。其外觀及顯微鏡下均為一個典型之腎上腺髓脂肪瘤。這種腫瘤並不常見，隨著經驗增加及診斷技術進步，漸漸有較多病例的報告，術前診斷已為可能。

並列摘要

Myelolipoma is a rare nonfunctioning benign tumor of the adrenal gland which consists of mature hemopoietic and adipose tissue. The tumor was first described by Gierke in 1905 and named by Oberling in 1929. According to the literature the majority of reported cases have been incidental findings at autopsy. After the first surgical removal of an adrenal myelolipoma with symptoms in 1957, only 67 consecutive cases had been reported upto now. In this study an asymptomatic myelolipoma of R’t adrenal gland in a 57-year-old woman with gallstone is reported. Thorough study with sonography, computed tomography, and angiography was performed. The tumor was resected successfully along with cholecystectomy.
The incidence of myelolipoma was reported to be 0.08 to 0.2 percent in autopsy findings. Etiology is unknown. Usually a myelolipoma remains clinically quiescent until massive growth. The most constant symptom is abdominal pain, which may be related to hemorrhage in the tumor. Myelolipomas arising from an ectopic adrenal gland have been reported. The tumor has no hormonal activity, but associated endocrine abnormalities have been described.
With the progressive development of imaging techniques, preoperative diagnosis of myelolipoma is possible. A dense echogenic appearance. Characteristic of fat, is seen on sonography. Sonography is also quite useful in distinguishing whether a mass is solid or cystic. Computed tomography is able to detect a small tumor of the adrenal gland with gigh accuracy. In CT images, myelolipomas appear as sharply marginated mostly inhomogeneously structured masses of different densities within the negative range, indicating the fatty tissue portion. A myelolipoma is angiographically hypovascular to avascular. Angiography helps to localize the mass to the adrenal gland. Under the guide of sonography or CT, tissue diagnosis by fine needle aspiration is also feasible.
With the wider application of modern imaging techniques, more myelolipomas will be found incidentally. For an incidentally discovered small adrenal tumor without any clinical symptoms, and initially observant procedure with CT controls in three-month intervals is recommended. Tumors that have already caused displacement symptoms should be excised surgically without delay. Larger, clinically quiescent myelolipomas should also be treated surgically since they may produce life-threatening shock symptoms at any time due to spontaneous hemorrhage.

並列關鍵字

adrenal tumor ； myelolipoma