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患者男,31岁,因体检B超发现左肾上腺占位2个月于1999年8月11日入院。患者均无心悸、头晕、晕厥、大汗淋漓、视物模糊、四肢无力、恶心、呕吐等临床表现。入院查体:血压18/10kpa。双肾区无隆起,未触及包块,双肾区无叩击痛。双输尿管径路无压痛。亦无第二性征异常变化。B超示:左肾上腺区可见2.6cm×2.4cm低回声区,边界清,内部回声均匀。CT示:左侧肾上腺区域2.41cm×1.81cm×3.0cm大小,边界清的软组织影。平扫CT值为23.9HU,增强CT值41.2HU,肿块紧贴胰体后部,内部密度尚均匀。与内侧大血管及后方分界清。右侧肾上腺显示良好。IVP示:双肾、输尿管、膀胱未见异常。术前诊断:左肾上腺无功能性腺瘤。于1999年8月31日在全麻下行左肾上腺腺瘤切除术,术中见肿块大小约3.0cm×2.5cm,包膜完整,光滑,质中,并与少许肾上腺紧密相连,肿物完全切除。术中心率、血压均无明显变化。术后病理,巨检:椭圆形肿块1个,大小约2.8cm×2.2cm×2.0cm,1侧连有少量肾上腺组织,切面实性,灰黄色,质地软。镜检:肿瘤细胞排列呈团块状弥漫性分布,瘤细胞体积大小不等,胞浆嗜酸性,核深染,并可见明显的病理性核分裂。肿瘤组织间有较厚的纤维间隔,部分肿瘤组织侵至包膜外,间质血管内也可见肿瘤细胞。病理诊断:
The patient male, 31 years old, was admitted to hospital on August 11th, 1999 because of a B-ultrasound of his physical examination and he was found occupying the left adrenal gland for 2 months. The patients had no clinical manifestations such as palpitation, dizziness, fainting, sweating, blurred vision, weakness in the limbs, nausea, and vomiting. Admission examination: blood pressure 18/10kpa. There was no bulge in the kidney area, no mass was touched, and no pain in the double kidney area. Double ureters no tenderness. There is also no abnormal change in secondary sexual characteristics. B ultrasound showed that the left adrenal area showed a low echo area of 2.6cm×2.4cm with clear boundary and uniform internal echo. The CT showed: the left adrenal region was 2.41cm × 1.81cm × 3.0cm in size, and the soft tissue shadow of the border was clear. The plain CT value was 23.9 HU, and the enhanced CT value was 41.2 HU. The mass was close to the back of the pancreatic body and the internal density was still uniform. With the medial great vessels and the rear demarcation. The right adrenal gland shows good. IVP showed no abnormalities in the kidneys, ureters, and bladders. Preoperative diagnosis: left adrenal gland without functional adenoma. On August 31, 1999, the left adrenal adenoma was removed under general anesthesia. The size of the tumor was approximately 3.0 cm x 2.5 cm during operation. The capsule was complete, smooth, qualitative, and closely connected with a small amount of adrenal gland. The tumor was completely resected. . The center rate and blood pressure did not change significantly. Postoperative pathology, giant examination: 1 oval mass, about 2.8cm × 2.2cm × 2.0cm in size, 1 side with a small amount of adrenal tissue, solid cut surface, grayish yellow, soft texture. Microscopic examination: The tumor cells showed a diffuse distribution of clumps, tumor cells of different sizes, eosinophilic cytoplasm, deep nuclear staining, and visible pathological nuclear fission. There is a thick fibrous space between the tumor tissues, and some tumors invade the outer envelope. Tumor cells are also found in the interstitial vessels. Pathological diagnosis: