Wilkinson Michael, Fanning Deirdre Mary, Moloney James, Flood Hugh
Urology Department, Midwestern Regional Hospital, Limerick, Ireland.
BMJ Case Rep. 2011 Sep 26;2011:bcr0520114169. doi: 10.1136/bcr.05.2011.4169.
The authors report a very rare case of adreno-cortical carcinoma arising in a giant adrenal pseudocyst. A 64-year-old woman presented to the emergency department with a 6 week history of progressively worsening severe left abdominal pain, anorexia, anergia and constipation. On examination, she was cachectic with tenderness over the left abdomen and flank. Medical history was significant for gastritis and anaemia. During her investigation, a well-defined para-renal 12×6 centimetre multi-loculated cyst, of uncertain origin was identified on CT. Ultrasound-guided biopsy was not diagnostic. MRI showed the cyst to be likely adrenal in origin. Serum and urinary catecholamines were unremarkable. At laparotomy an unresectable large, tense, fixed, cystic mass was seen to occupy the left side of the abdomen. The cyst was de-roofed. Pathology showed a high-grade poorly differentiated adreno-cortical carcinoma with a pseudo-capsule. She died 2 months postoperatively.
作者报告了一例极为罕见的起源于巨大肾上腺假性囊肿的肾上腺皮质癌病例。一名64岁女性因持续6周的进行性加重的严重左腹痛、厌食、乏力和便秘就诊于急诊科。检查时，她消瘦，左腹和侧腹有压痛。病史中胃炎和贫血较为显著。在检查过程中，CT发现一个边界清晰的12×6厘米肾旁多房性囊肿，起源不明。超声引导下活检未能明确诊断。MRI显示该囊肿可能起源于肾上腺。血清和尿儿茶酚胺无异常。剖腹手术时，可见一个无法切除的巨大、紧张、固定的囊性肿块占据腹部左侧。囊肿被去顶。病理显示为高级别低分化肾上腺皮质癌，有假包膜。她术后2个月死亡。
