一例由定期监测的亚厘米肾上腺偶发瘤引发的肾上腺皮质癌。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2024-01-31 Print Date: 2024-01-01 DOI:10.1530/EDM-23-0120
Sarah N Parry, Namson S Lau
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引用次数: 0

摘要

摘要:大约 80% 的肾上腺偶发瘤是良性的,发展成肾上腺皮质癌的情况极为罕见。这也是临床指南建议对偶发瘤进行长达 5 年的短期监测的主要原因。对于小于 1 厘米的病变,不建议进行常规监测。一位 70 岁的女士被诊断为右肾上腺 8 毫米非功能亢进性病变。她每年都接受生化和放射学评估,持续了 5 年,之后监测延长到每两年一次。病变大小稳定,放射学特征与良性腺瘤一致。在首次发现肾上腺病变 7 年后,她出现了急性腹痛。影像学检查显示她的右侧肾上腺有一个 7 厘米的病变,手术切除后经组织学证实为肾上腺皮质癌。她在一年后去世。临床指南已转向缩短偶发瘤的监测时间。尽管恶性转化是一种罕见的情况,但这有可能导致肾上腺皮质癌的诊断延迟,而肾上腺皮质癌是一种侵袭性很强的恶性肿瘤,预后很差。据我们所知,这是第一例发表的肾上腺小于 1 厘米的病变发展为肾上腺皮质癌的病例:学习要点:肾上腺偶发瘤越来越常见。临床实践指南有助于区分良性和恶性病变以及评估功能状态。肾上腺偶发瘤转变为肾上腺皮质癌虽然罕见,但已得到公认。
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A case of adrenal cortical carcinoma arising from a regularly monitored sub-centimetre adrenal incidentaloma.

Summary: Approximately 80% of adrenal incidentalomas are benign, and development into adrenal cortical cancer is extremely rare. This is a major reason behind clinical guidelines recommending surveillance of incidentalomas for a relatively short duration of up to 5 years. Surveillance of lesions less than 1 cm is not routinely recommended. A 70-year-old lady was diagnosed with a non-hyperfunctioning 8 mm right adrenal lesion. She underwent annual biochemical and radiological assessment for 5 years before surveillance was extended to 2-yearly intervals. The lesion was stable in size, and radiological characteristics were consistent with a benign adenoma. Seven years after the initial detection of the adrenal lesion, she developed acute abdominal pain. Imaging revealed a 7 cm right adrenal lesion, which was surgically resected and histologically confirmed to be adrenal cortical cancer. She died 1 year later. Clinical guidelines have moved towards a shortened duration of surveillance of incidentalomas. Even though malignant transformation is a rare event, it is possible that this will result in a delayed diagnosis of adrenal cortical cancer, a highly aggressive malignancy with a poor prognosis. To our knowledge, this is the first published case of an adrenal lesion of less than 1 cm developing into adrenal cortical cancer.

Learning points: Adrenal incidentalomas are increasingly common. Clinical practice guidelines exist to aid in differentiating benign and malignant lesions and assessing functional status. Transformation of adrenal incidentalomas to adrenal cortical carcinomas is a rare but recognised event.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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