犬嗜铬细胞瘤:诊断和治疗指南

M. F. van den Berg, S. Galac
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摘要

绒毛膜细胞瘤是肾上腺髓质绒毛膜细胞产生的神经内分泌肿瘤。临床症状主要与儿茶酚胺分泌过多有关,其次与肿瘤的占位性或侵袭性有关。相绒毛膜细胞瘤的诊断依赖于临床怀疑、生化检测、影像诊断和组织病理学。生化检测主要依靠测量血浆或尿液中的甲肾上腺素水平,与甲肾上腺素相比,正常甲肾上腺素的诊断效果更佳。肾上腺切除术是首选治疗方法,但在局部广泛侵犯、并发症或远处转移的病例中可能无法实施。建议采用对比增强计算机断层扫描来制定手术计划和筛查转移灶。血管侵犯是常见现象,但在许多病例中,手术仍是可行的选择。最近的研究对手术前使用α-受体阻滞剂的必要性提出了质疑,有必要进行随机对照临床试验对此进行评估。围手术期存活下来的狗通常都能长期存活。对于无法进行手术的患者,可以考虑使用酪氨酸激酶抑制剂进行药物治疗。鉴于目前缺乏有效的药物治疗,因此迫切需要确定新的治疗方案。本综述就犬绒毛膜细胞瘤的诊断和治疗提出了建议。
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Canine phaeochromocytoma: a guide to diagnosis and treatment
Phaeochromocytomas are neuroendocrine tumours arising from chromaffin cells of the adrenal medulla. Clinical signs are primarily associated with excessive catecholamine secretion and, to a lesser extent, with the space-occupying or invasive nature of the tumour. The diagnosis of phaeochromocytoma relies on clinical suspicion, biochemical testing, diagnostic imaging and histopathology. Biochemical testing mainly depends on the measurement of levels of plasma or urinary metanephrines, with normetanephrine demonstrating superior diagnostic performance compared to metanephrine. Adrenalectomy is the treatment of choice, but may not be possible in cases with extensive local invasion, concurrent disorders or distant metastasis. Contrast-enhanced computed tomography is recommended for surgical planning and metastasis screening. Vascular invasion is frequently observed, yet surgery remains a viable option in many cases. Recent studies question the necessity of alpha-blockade before surgery, and randomised controlled clinical trials are necessary to evaluate this. Long-term survival is often seen in dogs that survive the perioperative period. For patients in which surgery is not deemed feasible, medical treatment with tyrosine-kinase inhibitors may be considered. Given the current scarcity of effective medical treatment, there is an urgent need to identify novel therapeutic options. This review provides recommendations on the diagnosis and management of canine phaeochromocytoma.
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