Kido T, Takao T, Sagawa S, Kotoh K
Department of Surgery, Osaka Prefectural General Hospital, Japan.
Kyobu Geka. 1999 Jun;52(6):458-62.
A case of resection of metastatic multiple lung malignant pheochromocytoma is presented. Seven years before, total resection of the right adrenal gland and the right kidney was performed to remove a pheochromocytoma. During the post-surgical observation in the urology outpatient clinic, the blood noradrenalin concentration increased and multiple lung metastatic nidi were observed by chest X-ray. An excision was made to remove 3 wedge-shape metastatic nidi from both lungs. In the third year after the removal of the pulmonary metastatic nidi, a resection was again performed due to recurrence in the left retroperitoneal lymph node. Another recurrence was found in the S6 liver 1 year after the removal of the lymph node, and TAE and PEIT were conducted. When the recurrent metastatic nidi were found, the blood noradrenalin concentration was elevated, and it normalized after treatment. In this case, careful and long-term observation including monitoring the blood noradrenalin concentration in the outpatient clinic and positive surgical treatment proved effective. The patient is currently in good health without signs of recurrence 12 years after the removal of the primary adrenal nidus and 6 years after the removal of the pulmonary metastatic nidus.
本文报告一例转移性多发性肺恶性嗜铬细胞瘤切除术病例。七年前,为切除嗜铬细胞瘤,患者接受了右肾上腺和右肾全切术。在泌尿外科门诊术后观察期间,血去甲肾上腺素浓度升高,胸部X线检查发现肺部有多个转移灶。遂行手术切除双侧肺脏的3个楔形转移灶。切除肺部转移灶三年后,因左腹膜后淋巴结复发再次进行手术。切除淋巴结一年后,在肝脏S6段发现另一处复发,遂进行了肝动脉栓塞化疗(TAE)和经皮乙醇注射治疗(PEIT)。发现复发性转移灶时,血去甲肾上腺素浓度升高,治疗后恢复正常。在此病例中,包括在门诊监测血去甲肾上腺素浓度在内的仔细长期观察及积极的手术治疗被证明是有效的。患者在切除原发性肾上腺病灶12年后及切除肺部转移灶6年后,目前健康状况良好,无复发迹象。