Furuse H, Watase H, Ihara H, Kurita Y, Kageyama S, Ushiyama T, Suzuki K, Watanabe T, Maruyama Y, Kawabe K
Department of Urology, Hamamatsu University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1995 Apr;86(4):957-60. doi: 10.5980/jpnjurol1989.86.957.
A 39-year-old male presented with gross hematuria and left lower abdominal discomfort. Excretory urography showed a left ureteral stone and hydronephrosis. CT scans and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. Angiography revealed a hypervascular lesion at this area. The laboratory data showed a slightly decreased serum potassium level. In the endocrinological study, the serum deoxycorticosterone (DOC) level was markedly elevated. There was, however, no evidence of hypertension. The operation was performed on November 13, 1992. The tumor was almost separated from the left kidney, but an aberrant artery which divided from the renal artery and penetrated the renal parenchyma was found. Therefore, we had to carry out en bloc removal of the tumor together with the left kidney and the ureter which contained the ureteral stone. Pathological diagnosis was adrenocortical carcinoma. After the operation, hypokalemia and the serum concentration of DOC returned to normal range. Therefore, the tumor was diagnosed as DOC producing adrenocortical carcinoma. The patient was discharged 30 days after the operation with uneventful postoperative course. He received 2.5 g of op'-DDD a day. There was no evidence of distant metastasis or local recurrence 12 months after the operation. Nineteen cases of DOC producing adrenocortical tumor have been reported in the world literature. A case and a review of the literature are herein reported.
一名39岁男性因肉眼血尿和左下腹不适就诊。排泄性尿路造影显示左输尿管结石和肾积水。CT扫描和磁共振成像显示左肾上极有一实性肿块。血管造影显示该区域有一高血管病变。实验室检查数据显示血清钾水平略有下降。在内分泌学检查中，血清脱氧皮质酮（DOC）水平明显升高。然而，没有高血压的证据。手术于1992年11月13日进行。肿瘤几乎与左肾分离，但发现一条从肾动脉分出并穿透肾实质的异常动脉。因此，我们不得不将肿瘤与左肾及包含输尿管结石的输尿管一并整块切除。病理诊断为肾上腺皮质癌。术后低钾血症和血清DOC浓度恢复到正常范围。因此，该肿瘤被诊断为产生DOC的肾上腺皮质癌。患者术后30天出院，术后过程顺利。他每天接受2.5克邻对滴滴滴（op'-DDD）治疗。术后12个月没有远处转移或局部复发的证据。世界文献中已报道19例产生DOC的肾上腺皮质肿瘤。本文报告1例并对文献进行综述。
