Fronticelli C M, Gentilli S, Quiriconi F, Ferrero A, Masenti E
Sixth Division of General Surgery, University of Turin, Italy.
Panminerva Med. 1995 Jun;37(2):60-4.
The authors present their experience about surgery in adrenal gland incidentaloma, during a period of 12 years (1982-1993), at the VI Division of General Surgery, University of Turin. In 17 patients, of 70 who underwent adrenalectomy, the adrenal neoplasm was located thanks to a diagnostic investigation (ECI or CT) executed for other reasons. In ten cases was diagnosed adenoma, in five cases carcinoma, in two cases cysts. In the diagnostic approach to adrenal incidentaloma we did not search for possible hormonal activity, since the patients had been previously selected from specialized endocrinological centres. At present, biological markers not being certain or absolute radiological significance so as to detect benignant from malignant forms. In accordance with international Literature the size of the neoplasm is the discriminant element for adrenalectomy. We have removed the incidentaloma in all cases, be it clinically or subclinically functional and the silent forms > 4 cm as we have observed a statistically significant difference (p < 0.0002) between the benign and malignant lesions, particularly those measuring more than 4 cm in diameter. We suggest a screening with CT scan every three months in lesions < 4 cm, silent and those > 4 cm in patients over sixty years with a morphological aspect of the bening form.
作者介绍了他们在都灵大学普通外科第六科室12年（1982 - 1993年）间对肾上腺偶发瘤进行手术的经验。在接受肾上腺切除术的70例患者中，有17例患者的肾上腺肿瘤是因其他原因进行诊断性检查（ECI或CT）时被发现的。其中，诊断为腺瘤的有10例，癌5例，囊肿2例。在肾上腺偶发瘤的诊断方法中，我们未探究其可能的激素活性，因为这些患者此前是从专业内分泌中心挑选出来的。目前，生物学标志物尚无确定或绝对的放射学意义以区分良性和恶性肿瘤。根据国际文献，肿瘤大小是决定是否进行肾上腺切除术的判别因素。我们对所有病例的偶发瘤均进行了切除，无论其具有临床或亚临床功能，还是直径大于4 cm的无症状肿瘤，因为我们观察到良性和恶性病变之间存在统计学显著差异（p < 0.0002），尤其是直径超过4 cm的病变。对于直径小于4 cm、无症状的肿瘤以及60岁以上形态呈良性的直径大于4 cm的肿瘤患者，我们建议每三个月进行一次CT扫描筛查。
