Pulmonary Metastasis of Adrenocortical Carcinoma Mimics Pulmonary Tuberculosis-A Case Report

疑似肺結核病變的腎上腺皮質癌肺部遠處轉移：病例報告

楊家慧 ； Chia-Hui Yang ； 張天鈞(Tien-Chun Chang)

《中華民國內分泌暨糖尿病學會會刊》 19卷2期 (2006/01) Pp. 57-66

https://doi.org/10.7101/ED.200601.0057

摘要

腎上腺皮質癌是一種罕見且預後不佳的惡性腫瘤。將近百分之三十至八十五的腎上腺皮質癌以遠處轉移為最初的表現，本文描述這樣的一個病例，開始時有呼吸急促和肺部多發性空洞化病變，而疑似肺結核。病患為一位三十四歲男性，臨床上以新發生的高血壓、多血症、青春痘及咳嗽表現。胸部X光影像呈現多發性空洞化病變和肺泡浸潤，如同肺結核，因此先以抗肺結核藥物治療。繼之，內分泌檢查顯示早晨八時及晚間十時的腎上腺皮質素值分別是30.7μg/dL和50.7μg/dL、腎上皮促素早晨八時是10.1pg/mL。胸、腹部的電腦斷層影像顯現腎上腺巨大腫瘤，而肺部可能為轉移病變。肋膜病變及腎上腺腫瘤經超音波導引細針抽吸細胞學檢查診斷為腎上腺皮質癌併肺轉移。病人接受腎上腺手術摘除並使用低劑量的抑制腎上腺藥物mitotane治療（每天1.6g）。然而，病人在一個月後因急性呼吸衰竭去世。本病例顯示腎上腺皮質癌的肺部轉移可能以類肺結核的多發性空洞化病變來表現。

並列摘要

Adrenocortical carcinoma is a rare malignancy associated with dismal prognosis;
a significant proportion (30% to 85%) of patients have distant metastasis at the time of initial presentation. Here we report such a patient who initially presented with dyspnea and multiple cavity formation of the lung, which mimicked pulmonary tuberculosis. He was a 34-year-old male and presented with new onset of hypertension, plethora, acne, cough and dyspnea for few weeks. A chest roentogram revealed multiple cavity formation over bilateral upper lung fields with alveolar infiltration and pulmonary tuberculosis was suspected. Patient was initially treated with four combined regimen of antituberculosis drugs. Then endocrine profile revealed cortisol 30.7μg/dL at 8 a.m. (reference range: 5-25μg/dL) and 50.7 μg/dL at 10 p.m., and ACTH was 10.1 pg/ml at 8 a.m. (reference range: 9-52 pg/ml). Computerized tomography of adrenal gland showed a huge left adrenal tumor. Impression of left adrenocortical carcinoma with Cushing's syndrome and lung metastasis was made after ultrasound guided fine needle aspiration cytology of left adrenal mass and chest. Patient received left adrenalectomy, and accepted low dose of mitotane treatment after operation. However he died of acute respiratory failure about one month after diagnosis. Adrenocortical carcinoma with lung metastasis could present as multiple cavity formation on bilateral upper lung fields on chest X-ray, and differential diagnosis with pulmonary tuberculosis should be made carefully.

並列關鍵字

adrenocortical carcinoma ； Cushing's syndrome ； lung metastasis ； pulmonary tuberculosis