Ramacciotti C, Schneegans O, Lang H, Lindner V, Claria M, Moreau F, Chenard M P, Pinget M, Kessler L
Service d'Endocrinologie, Diabète et Maladies Métaboliques, Hôpital Civil, CHU Strasbourg, France.
Ann Endocrinol (Paris). 2006 Mar;67(1):14-9. doi: 10.1016/s0003-4266(06)72534-3.
We report an observation of strong bilateral uptake on a PET-CT scan compatible with activation of brown adipose tissue in a patient with extra-adrenal pheochromocytoma. A 42-year-old man was hospitalized for hypersudation together with weight loss and palpitations. Heart rate was 120 bpm and fasting blood glucose 1.36 g/l. Endocrine explorations revealed elevated serum chromogranine which reached 517 ng/ml (19-38). The norepinephrine level reached 49.7 nmol/l (<4.00) and urinary norepinephrine and normetanephrine levels reached 13977 nmol/24h (<414) and 32 micromol/24h (0.4-2.5) respectively. The thoraco-abdominal and pelvic scan showed a 6 cm diameter paraaortic hypervascularized mass with an infiltrative lesion of both perirenal area and mediastinal tissue without adenopathies. The abdominal MRI revealed the mass with a low intensity signal in T1 and a slight high intensity signal in T2. MIBG and octreoscan scintigraphies were negative. 18F-DG PET showed intensed uptake in the tumor mass together with intense, diffuse and bilateral uptake above and below the diaphragm. The mass was resected. Histological examination of the surgical specimen confirmed the diagnosis of extra-adrenal pheochromocytoma with an index of 13% cellular proliferation without cell atypia. There was a hypervascularization with small islets of brown adipose tissue in the perirenal fat. Both plasmatic and urinary catecholamines decreased to the normal range after the operation and PET-scan normalized. Bilateral spread of the radiotracer uptake was probably due to brown adipose tissue activation by excessive sympathetic stimulation induced by catecholamines released by the tumor.
我们报告了1例肾上腺外嗜铬细胞瘤患者，其PET-CT扫描显示双侧摄取强烈，符合棕色脂肪组织激活的表现。一名42岁男性因多汗伴体重减轻和心悸入院。心率为120次/分，空腹血糖为1.36 g/l。内分泌检查显示血清嗜铬粒蛋白升高，达517 ng/ml（19 - 38）。去甲肾上腺素水平达49.7 nmol/l（<4.00），尿去甲肾上腺素和去甲变肾上腺素水平分别达13977 nmol/24h（<414）和32 μmol/24h（0.4 - 2.5）。胸腹盆腔扫描显示腹主动脉旁有一个直径6 cm的高血管化肿块，双肾周区域和纵隔组织有浸润性病变，无淋巴结肿大。腹部MRI显示该肿块在T1加权像上呈低信号，在T2加权像上呈轻度高信号。MIBG和奥曲肽扫描均为阴性。18F-DG PET显示肿瘤肿块摄取强烈，同时在横膈上下有强烈、弥漫性的双侧摄取。肿块被切除。手术标本的组织学检查确诊为肾上腺外嗜铬细胞瘤，细胞增殖指数为13%，无细胞异型性。肾周脂肪中有小的棕色脂肪组织岛伴血管增生。术后血浆和尿儿茶酚胺均降至正常范围，PET扫描也恢复正常。放射性示踪剂摄取的双侧扩散可能是由于肿瘤释放的儿茶酚胺引起的过度交感神经刺激导致棕色脂肪组织激活所致。
