Vanderveen Kimberly A, Thompson Scott M, Callstrom Matthew R, Young William F, Grant Clive S, Farley David R, Richards Melanie L, Thompson Geoffrey B
Department of Surgery, Mayo Medical School, Rochester, MN, USA.
Surgery. 2009 Dec;146(6):1158-66. doi: 10.1016/j.surg.2009.09.013.
Pheochromocytomas and paragangliomas are highly vascular neuroendocrine neoplasms that often secrete catecholamines. Percutaneous biopsy has been associated with life-threatening hemorrhage, hypertensive crisis, capsular disruption with tumor implantation, and death. We sought to determine the outcomes of biopsy in 20 consecutive patients.
We reviewed retrospectively the medical records of patients with biopsied pheochromocytomas and paragangliomas referred to our Endocrine Division for subsequent management between 1995 and 2005. Biopsy complications, operative findings, and outcomes were reviewed.
Twenty patients (14 pheochromocytomas and 6 paragangliomas) were biopsied percutaneously prior to referral. Mean tumor diameter was 6.4 cm (range, 1-15). Pre-biopsy biochemical testing was not performed in 90% of patients, and was negative in the remainder. Fourteen patients (70%) developed a biopsy-related complication, including: increased difficulty of the definitive operation in 7 of 17 (41%) operative cases with 1 patient requiring conversion to an open procedure; severe hypertension (15%); hematoma (30%); incorrect or inadequate biopsy (25%); severe pain (25%); and delay in surgical treatment (15%). Mean follow-up was 58 months, with 4 tumor-related deaths and 2 recurrences.
Biochemical testing prior to biopsy of adrenal or suspicious retroperitoneal masses is critical to exclude a catecholamine-secreting neoplasm because serious complications and increased operative difficulty can result.
嗜铬细胞瘤和副神经节瘤是富含血管的神经内分泌肿瘤，常分泌儿茶酚胺。经皮活检与危及生命的出血、高血压危象、肿瘤种植导致的包膜破裂及死亡相关。我们试图确定连续20例患者活检的结果。
我们回顾性分析了1995年至2005年间因活检嗜铬细胞瘤和副神经节瘤而转诊至我们内分泌科进行后续治疗的患者的病历。对活检并发症、手术发现及结果进行了回顾。
20例患者（14例嗜铬细胞瘤和6例副神经节瘤）在转诊前接受了经皮活检。肿瘤平均直径为6.4厘米（范围1 - 15厘米）。90%的患者活检前未进行生化检测，其余患者检测结果为阴性。14例患者（70%）出现了与活检相关的并发症，包括：17例手术病例中的7例（41%）确定性手术难度增加，其中1例患者需转为开放手术；严重高血压（15%）；血肿（30%）；活检错误或不充分（25%）；严重疼痛（25%）；以及手术治疗延迟（15%）。平均随访58个月，有4例肿瘤相关死亡和2例复发。
肾上腺或可疑腹膜后肿块活检前进行生化检测对于排除分泌儿茶酚胺的肿瘤至关重要，因为这可能导致严重并发症和手术难度增加。
