Endo Keisuke, Joraku Akira, Kawai Kouji, Ikeda Atsushi, Kimura Tomokazu, Ishitsuka Ryutaro, Kandori Shuya, Waku Natsui, Hoshi Akio, Kojima Takahiro, Amano Taishi, Hara Tadashi, Nasu Katsuhiro, Minami Manabu, Nishiyama Hiroyuki
The Department of Urology, Faculty of Medicine, University of Tsukuba.
The Department of Radiology, Faculty of Medicine, University of Tsukuba.
Hinyokika Kiyo. 2021 Nov;67(11):483-488. doi: 10.14989/ActaUrolJap_67_11_483.
A 59-year-old woman presented with a left adrenal tumor 4 cm in diameter. The ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy showed apparent accumulation in the left adrenal tumor. However, the patient had no sign or symptoms suggesting pheochromocytoma. No biochemical evidence of catecholamine excess was noticed. Computed tomography (CT) revealed relatively strong enhancement in the arterial phase, which persisted until the portal phase. The computed tomography (CT) and magnetic resonance imaging showed 2 liver nodule suspected to be metastatic tumors. No ¹²³I-MIBG accumulation was seen in these nodules. CT also showed thyroid nodules with calcification, which suggested papillary thyroid cancer. Based on the findings, open left adrenalectomy, partial hepatectomy and segmentectomy were performed under the clinical diagnosis of pheochromocytoma and metastatic liver tumors. Histopathological diagnosis was adrenocortical cancer. There was only lymphocyte infiltration in the liver nodules. Postoperative recovery was uneventful, and the patient underwent partial thyroidectomy 6 months later. The pathological diagnosis was papillary thyroid cancer. She has been without recurrence or metastases for 18 months after adrenalectomy. We found only 6 cases of MIBG scintigraphy-positive adrenocortical cancer in the literature. The mechanisms for MIBG uptake in adrenocortical cancer are discussed with a review of the literature.
一名59岁女性因直径4厘米的左肾上腺肿瘤前来就诊。¹²³I-间碘苄胍（MIBG）闪烁扫描显示左肾上腺肿瘤有明显放射性浓聚。然而，患者没有提示嗜铬细胞瘤的体征或症状。未发现儿茶酚胺过量的生化证据。计算机断层扫描（CT）显示动脉期有相对较强的强化，并持续至门静脉期。CT和磁共振成像显示肝脏有2个结节，怀疑是转移瘤。这些结节未见¹²³I-MIBG放射性浓聚。CT还显示甲状腺结节有钙化，提示为甲状腺乳头状癌。基于这些发现，在嗜铬细胞瘤和肝转移瘤的临床诊断下，实施了左肾上腺切除术、肝部分切除术和肝段切除术。组织病理学诊断为肾上腺皮质癌。肝脏结节仅有淋巴细胞浸润。术后恢复顺利，患者6个月后接受了甲状腺部分切除术。病理诊断为甲状腺乳头状癌。肾上腺切除术后18个月，她未出现复发或转移。我们在文献中仅发现6例MIBG闪烁扫描阳性的肾上腺皮质癌。结合文献复习，对肾上腺皮质癌摄取MIBG的机制进行了讨论。
