Özkul Neslihan, Kann Peter Herbert
Faculty of Medicine, University Hospital Giessen and Marburg, Philipps University, Centre for Endocrinology, Diabetology & Osteology, Marburg, Germany.
Clinic for Anaesthesiology, University Hospital Basel, Basel, Switzerland.
Ultrasound Int Open. 2021 Nov 17;7(2):E64-E70. doi: 10.1055/a-1626-1678. eCollection 2021 Aug.
Pheochromocytoma (PCC) and adrenocortical carcinoma (ACC) are two rare endocrine diseases. Early diagnosis is crucial to significantly reduce morbidity and mortality. In this study, we used endoscopic ultrasound (EUS) for high-resolution imaging to investigate the endosonographic morphology pattern of PCC and ACC. This retrospective cohort study included 58 PCC/ACC lesions diagnosed by EUS imaging at two tertiary care centers between 1997 and 2015. The following groups were defined by histology or by the presence of a pheochromocytoma-associated syndrome without histological proof: bPCC (benign PCC), mPCC (malignant PCC), and ACC. In our cohort, mPCC tended to be larger at the time of diagnosis (n=5; 39.9±41.9 mm) than bPCC (n=46; 27.3 ±20.8 mm, P=0.548). ACC lesions were significantly larger (n=7; 50.6±14.8 mm) than bPCC and mPCC (n=51; 28.5±23.3 mm, P=0.002). In EUS, bPCC and ACC lesions frequently appeared to have a round shape and nodular structure. bPCC and ACC tended to be more hyperechoic (P=0.112 and P=0.558, respectively) and heterogeneous (P=0.501 and P=0.098, respectively) than mPCC. Compared to PCC, ACC did not show high hyperperfusion (P=0.022). In contrast to adenoma, all tumor entities showed hypo-/anechoic areas within the tumor (P<0.05). No significant differences in EUS morphology were found to reliably distinguish benign from malignant PCC and ACC lesions. However, EUS may be a reasonable alternative or complementary method to conventional imaging techniques for the early detection of these tumor entities.
嗜铬细胞瘤（PCC）和肾上腺皮质癌（ACC）是两种罕见的内分泌疾病。早期诊断对于显著降低发病率和死亡率至关重要。在本研究中，我们使用内镜超声（EUS）进行高分辨率成像，以研究PCC和ACC的内镜超声形态模式。这项回顾性队列研究纳入了1997年至2015年间在两个三级医疗中心通过EUS成像诊断的58例PCC/ACC病变。根据组织学或存在嗜铬细胞瘤相关综合征但无组织学证据定义了以下几组：bPCC（良性PCC）、mPCC（恶性PCC）和ACC。在我们的队列中，mPCC在诊断时往往比bPCC更大（n = 5；39.9±41.9毫米）（n = 46；27.3±20.8毫米，P = 0.548）。ACC病变明显大于bPCC和mPCC（n = 7；50.6±14.8毫米）（n = 51；28.5±23.3毫米，P = 0.002）。在EUS中，bPCC和ACC病变常呈圆形和结节状结构。bPCC和ACC往往比mPCC回声更强（分别为P = 0.112和P = 0.558）且更不均匀（分别为P = 0.501和P = 0.098）。与PCC相比，ACC未显示出高灌注（P = 0.022）。与腺瘤不同，所有肿瘤实体在肿瘤内均显示低回声/无回声区域（P<0.05）。未发现EUS形态有显著差异可可靠地区分良性与恶性PCC和ACC病变。然而，EUS可能是传统成像技术用于早期检测这些肿瘤实体的合理替代或补充方法。
