Otsubo Kanji, Kobayashi Shinjiro, Ida Keisuke, Katayama Masafumi, Koizumi Satoshi, Koike Junki, Otsubo Takehito, Tsuchihashi Atsuhito
Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
Case Rep Gastroenterol. 2021 Dec 23;15(3):978-984. doi: 10.1159/000520626. eCollection 2021 Sep-Dec.
Adrenal lipoma is a rare, benign tumor, reported to account for 0.7% of primary adrenal tumors. A 69-year-old man presented with left lateral abdominal pain. Computed tomography (CT) was performed, and a huge, irregularly shaped retroperitoneal tumor of uneven internal density was identified, with the border between the tumor and the pancreas and kidney being unclear. Active hemorrhage was also depicted. The tumor consisted mainly of fat, with the exception of the hematoma; it measured 200 mm; and the boundary between it and nearby organs, such as the pancreas, was unclear. Despite angiography being performed twice, the responsible vessel was not identified. Thus, for the purpose of both diagnosis and treatment, we resected the tumor, and considering the possibility of a malignancy, such as liposarcoma, we also resected the pancreatic body and tail and the spleen. The final histopathologic diagnosis was benign adrenal lipoma with hemorrhage, with no invasion to surrounding tissue. Hemorrhage within an adrenal tumor is rare. Most adrenal lipomas are small "incidentalomas" and asymptomatic. With development of a large adrenal lipoma comes the possibility of hemorrhage along with the possibility of features suggestive of malignancy. We encountered a giant adrenal lipoma with hemorrhage and, because of the aforementioned features, performed extended surgical resection, seen in retrospect as oversurgery. The widespread use of CT has led to an increased number of reported cases of adrenal lipoma. We anticipate an accumulation of case reports, which will allow for development of an appropriate treatment algorithm.
肾上腺脂肪瘤是一种罕见的良性肿瘤，据报道占原发性肾上腺肿瘤的0.7%。一名69岁男性因左侧腹痛就诊。进行了计算机断层扫描（CT），发现一个巨大的、形状不规则的腹膜后肿瘤，内部密度不均匀，肿瘤与胰腺和肾脏之间的边界不清，还显示有活动性出血。肿瘤主要由脂肪组成，除血肿外；其大小为200毫米；它与胰腺等附近器官之间的边界不清。尽管进行了两次血管造影，但未识别出责任血管。因此，为了诊断和治疗，我们切除了肿瘤，考虑到存在脂肪肉瘤等恶性肿瘤的可能性，我们还切除了胰体、胰尾和脾脏。最终组织病理学诊断为伴有出血的良性肾上腺脂肪瘤，无周围组织侵犯。肾上腺肿瘤内出血罕见。大多数肾上腺脂肪瘤是小的“偶发瘤”且无症状。随着肾上腺大脂肪瘤的发展，出血的可能性增加，同时也可能出现提示恶性肿瘤的特征。我们遇到了一例伴有出血的巨大肾上腺脂肪瘤，由于上述特征，进行了扩大手术切除，事后看来这是过度治疗。CT的广泛应用导致肾上腺脂肪瘤的报告病例数增加。我们预计病例报告会不断积累，这将有助于制定合适的治疗方案。
