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病例报告:脾切除术后左肾上腺区副脾误诊为肾上腺肿瘤。

Case report: Misdiagnosis of accessory spleen in the left adrenal region as an adrenal tumour after splenectomy.

作者信息

Zou Yuhua, Xie Xiaojuan, Yan Sheng, Wu Gengqing, Liu Quanliang

机构信息

Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.

Department of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.

出版信息

Front Surg. 2022 Oct 17;9:1017603. doi: 10.3389/fsurg.2022.1017603. eCollection 2022.

Abstract

BACKGROUND

Adrenal tumours are common in urology and endocrinology, and the diagnosis of adrenal tumours were mainly depends on imaging diagnosis. Howerver, misdiagnosis can still occur for some adrenal space-occupying lesions without specific manifestations or abnormal biochemical indexes.

METHODS

We report the case of a 55-year-old patient with a soft-tissue mass in the left adrenal region, and have no specific manifestations or abnormalities in biochemical indexes. The patient had undergone open splenectomy 20 years ago for splenic rupture caused by traffic-accident trauma, and had a 10-year special history of hypertension. Because of the uncertain nature of the mass, surgical treatment was recommended.

RESULTS

The surgeon managed to remove the left adrenal region mass. During the surgery, the adrenal source was excluded. In the histological examination, the splenic corpuscle and splenic medullary structure were seen under the microscope, and an accessory spleen was diagnosed.

CONCLUSIONS

The accessory spleen was located in the adrenal region rarely, and can easily be misdiagnosed as an adrenal tumour. When the cases show abnormal adrenal space-occupying lesions in imaging examinations, non-adrenal diseases should be considered. we need to combine different imaging techniques for analysis, and think more about it, avoid misdiagnosis leading to unnecessary surgery.

摘要

背景

肾上腺肿瘤在泌尿外科和内分泌科较为常见,肾上腺肿瘤的诊断主要依赖影像学诊断。然而,对于一些无特异性表现或生化指标异常的肾上腺占位性病变,仍可能发生误诊。

方法

我们报告一例55岁患者,左肾上腺区有一软组织肿块,且无特异性表现及生化指标异常。该患者20年前因交通事故创伤导致脾破裂接受了开放性脾切除术,并有10年高血压病史。由于肿块性质不确定,建议手术治疗。

结果

外科医生成功切除左肾上腺区肿块。手术过程中排除了肾上腺来源。组织学检查显微镜下可见脾小体和脾髓质结构,诊断为副脾。

结论

副脾极少位于肾上腺区,易被误诊为肾上腺肿瘤。当影像学检查显示肾上腺占位性病变异常时,应考虑非肾上腺疾病。我们需要结合不同的影像学技术进行分析,并多加思考,避免误诊导致不必要的手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/01a1/9618801/74ff301cf1ba/fsurg-09-1017603-g001.jpg

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