Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)
Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)
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直径大于5cm的肾上腺病变临床分析（附251例分析）
DOI：
10.1186/s12957-019-1765-7
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发表时间：
2019-12
期刊：
影响因子：
--
通讯作者：
Wang Jianbo
中科院分区：
文献类型：
--
作者：
Zang Zongzong;Wang Lina;Chen Jing;Li Xiunan;Liu Dikuan;Cao Tianyu;Yang Xuehan;Huang Hongwei;Wang Xuejian;Song Xishuang;Yang Deyong;Wang Jianbo
背景：描述≥5 cm大肾上腺瘤（large adrenal tumor, LATs）的病理分布、影像学表现、手术处理及预后。方法：对251例LATs患者进行病理或临床诊断分析。手术方面，开腹肾上腺切除术89例，腹腔镜肾上腺切除术89例。对32例双侧肿瘤患者的临床特点进行分析。测定了43例肾上腺转移患者和29例原发性肾上腺恶性肿瘤患者的生存率。分析117例患者的CT特征，包括肿瘤直径、形状、边缘、异质性、坏死、钙化、对比前衰减、对比衰减等。结果：大多数LATs仍为良性，但有较高的恶性概率。良性LATs占68.13%，主要为肾上腺囊肿（19.52%）、嗜铬细胞瘤（18.73%）、良性腺瘤（16.73%）和骨髓脂肪瘤（7.17%）。恶性LATs占28.69%，主要包括肾上腺皮质癌（8.76%）和转移瘤（17.13%）。腹腔镜手术比开放手术创伤更小。它也更安全，术后恢复更快，但也有缺点，不能完全取代开放手术。CT表现对良恶性肿瘤的诊断有明显的特异性。例如，良性腺瘤的造影前衰减较小（< 10 Hu），而恶性肾上腺肿瘤的造影前衰减则较高。肾上腺恶性癌中，肾上腺原发恶性肿瘤预后好于肾上腺转移瘤（平均生存期19.17个月vs 9.49个月）。无转移的原发性肾上腺皮质癌预后好于原发性肾上腺皮质癌转移（平均生存期23.71个月vs 12.75个月），肾上腺单发转移预后好于一般多发性转移癌（平均生存期14.95个月vs 5.17个月）。结论：LATs多为良性；然而，它们仍然有很大的可能性是恶性肿瘤。了解LATs的临床病理特征有助于选择更有效的临床治疗方案。
BACKGROUND:To describe the pathological distribution, imaging manifestations, and surgical managements and prognosis of large adrenal tumors (LATs) ≥ 5 cm METHODS: A total of 251 patients with LATs were analyzed on the basis of pathological or clinical diagnosis. Regarding surgery, open adrenalectomy was performed on 89 patients, and laparoscopic adrenalectomy was performed on 89 patients. Thirty-two patients with bilateral tumors were analyzed in terms of clinical characteristics. The survival rate was determined for 43 patients with adrenal metastases and 29 patients with primary adrenal malignancies. The CT characteristics including tumor diameter, shape, edge, heterogeneity, necrosis, calcification, pre-contrast attenuation, and contrast attenuation were analyzed for 117 patients..RESULTS:The majority of LATs were still benign, but they had a higher probability to be malignant. Benign LATs made up 68.13% of all cases, mainly adrenal cysts (19.52%), pheochromocytoma (18.73%), benign adenoma (16.73%), and myelolipoma (7.17%). Malignant LATs accounted for 28.69% of cases, mainly including adrenocortical carcinoma (8.76%) and metastases (17.13%). Laparoscopic surgery was found to involve less trauma than open surgery. It was also safer and postoperative recovery was faster, but it had drawbacks and could not completely replace open surgery. CT features had obvious specificity for the diagnosis of benign and malignant tumors. For example, benign adenomas had a smaller pre-contrast (< 10 Hu) whereas malignant adrenal tumors had, on the contrary, higher attenuation. Regarding adrenal malignant carcinoma, adrenal primary malignant tumors showed a better prognosis than adrenal metastases (mean survival of 19.17 months vs 9.49 months). Primary adrenal cortical carcinoma without metastasis had a better prognosis than primary adrenal cortical carcinoma metastasis (mean survival of 23.71 months vs 12.75 months), and adrenal solitary metastasis had a better prognosis than general multiple metastatic carcinoma (mean survival of 14.95 months vs 5.17 months)..CONCLUSION:LATs were more likely to be benign; however, they still had a high probability of being a malignant tumor. Understanding the clinicopathological characteristics of LATs can facilitate selection of more effective clinical treatment options.
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影响因子：
19.7
作者：
Peña, CS;Boland, GWL;Mueller, PR
通讯作者：
Mueller, PR
影响因子：
2.7
作者：
Almeida, Madson Q.;Bezerra-Neto, Joao Evangelista;Fragoso, Maria Candida B.V.
通讯作者：
Fragoso, Maria Candida B.V.
影响因子：
2.1
作者：
A. Cichocki;R. Samsel;L. Papierska;K. Roszkowska-Purska;K. Nowak;Z. Jodkiewicz;A. Kasperlik-Załuska
通讯作者：
A. Cichocki;R. Samsel;L. Papierska;K. Roszkowska-Purska;K. Nowak;Z. Jodkiewicz;A. Kasperlik-Załuska
影响因子：
5.8
作者：
Liao, Chun-Hou;Chueh, Shih-Chieh;Chen, Jun
通讯作者：
Chen, Jun
影响因子：
2.1
作者：
A. Kasperlik-Załuska;J. Słowińska-Srzednicka;E. Rosłonowska;M. Kochman;W. Jeske;M. Otto;A. Cichocki-A.-Cichoc
通讯作者：
A. Kasperlik-Załuska;J. Słowińska-Srzednicka;E. Rosłonowska;M. Kochman;W. Jeske;M. Otto;A. Cichocki-A.-Cichoc