中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
3期
165-170
,共6页
江昌新%曾智%王婷%刘欣%刘蓉%李颖
江昌新%曾智%王婷%劉訢%劉蓉%李穎
강창신%증지%왕정%류흔%류용%리영
肾上腺皮质疾病%病理学,临床
腎上腺皮質疾病%病理學,臨床
신상선피질질병%병이학,림상
Adrenal cortex disease%Pathology,clinical
目的 探讨肾上腺皮质疾病及肾上腺皮质球状带、束状带和网状带增生、腺瘤、腺癌的临床病理学特点及相互关系. 方法 天津医科大学总医院病理科1993 - 2008年外科病理检查总数167 702例,其中肾上腺疾病910例(0.54％)、肾上腺皮质疾病631例(0.38％).对检出率、构成比、平均诊断年龄、性别比例及临床表现、病理变化进行统计学分析. 结果 肾上腺皮质球状带、束状带、网状带病变分别为310例(49.13％)、319例(50.55％)、2例(0.32％).16年中肾上腺疾病、肾上腺皮质疾病检出率和肾上腺皮质球、束状带疾病构成比及各带增生、腺瘤、腺癌的构成比均无变化趋势,均表现为腺瘤＞增生＞腺癌的发病规律.球、束、网状带功能性病变( 90.97％、79.00％、100.00％)明显高于无功能性病变(9.03％、21.00％、0％),并均以女性多见.无功能性球状带腺瘤、腺癌和束状带增生、腺瘤的平均发病年龄分别高于功能性病变.球状带腺癌的发病年龄(62.7岁)明显高于增生(47.8岁)、腺瘤(44.8岁)；束状带腺癌平均年龄和男性平均年龄(44.3岁,50.0岁)分别高于腺瘤(44.0岁,49.1岁)、增生(41.5岁,40.9岁),而女性平均年龄(38.7岁)明显低于腺瘤(42.4岁)、增生(41.9岁),无功能性腺癌发病年龄最低(34.4岁).功能性和无功能性腺癌直径均较大(球状带为4.3 cm和4.0 cm,束状带为7.1 cm和8.0 cm),癌细胞异形明显并伴较多出血、坏死和包膜、脉管侵犯.功能性肾上腺皮质球、束、网状带的增生、腺瘤中临床Conn、库欣或生殖器综合征伴有高血压症状比例明显高于不伴有高血压组或仅有单纯高血压症状组,但病变体积没有明显差异.其中功能性球、束状带腺瘤略小于无功能性,直径分别为1.7、2.3和2.3、2.4 cm,球状带腺瘤平均直径小于束状带.查体发现的无功能性球、束状带腺瘤的直径大于非内分泌症状者(2.5、2.0和2.5、2.3 cm).伴生殖器综合征患者7例(男2例,女5例),其中束状带腺瘤4例、腺癌1例,网状带增生、腺瘤各1例. 结论 遗传学改变在肾上腺皮质疾病发生中具有重要作用,而环境因素对其发病趋势变化的影响相对较弱.影像学检查已作为肾上腺皮质疾病的首选定位检查方法,对评价肿瘤良、恶性有一定提示作用.肾上腺皮质疾病临床表现与病理变化密切相关,确切的病变类型和肿瘤性质仍要由病理学检查确定.
目的 探討腎上腺皮質疾病及腎上腺皮質毬狀帶、束狀帶和網狀帶增生、腺瘤、腺癌的臨床病理學特點及相互關繫. 方法 天津醫科大學總醫院病理科1993 - 2008年外科病理檢查總數167 702例,其中腎上腺疾病910例(0.54％)、腎上腺皮質疾病631例(0.38％).對檢齣率、構成比、平均診斷年齡、性彆比例及臨床錶現、病理變化進行統計學分析. 結果 腎上腺皮質毬狀帶、束狀帶、網狀帶病變分彆為310例(49.13％)、319例(50.55％)、2例(0.32％).16年中腎上腺疾病、腎上腺皮質疾病檢齣率和腎上腺皮質毬、束狀帶疾病構成比及各帶增生、腺瘤、腺癌的構成比均無變化趨勢,均錶現為腺瘤＞增生＞腺癌的髮病規律.毬、束、網狀帶功能性病變( 90.97％、79.00％、100.00％)明顯高于無功能性病變(9.03％、21.00％、0％),併均以女性多見.無功能性毬狀帶腺瘤、腺癌和束狀帶增生、腺瘤的平均髮病年齡分彆高于功能性病變.毬狀帶腺癌的髮病年齡(62.7歲)明顯高于增生(47.8歲)、腺瘤(44.8歲)；束狀帶腺癌平均年齡和男性平均年齡(44.3歲,50.0歲)分彆高于腺瘤(44.0歲,49.1歲)、增生(41.5歲,40.9歲),而女性平均年齡(38.7歲)明顯低于腺瘤(42.4歲)、增生(41.9歲),無功能性腺癌髮病年齡最低(34.4歲).功能性和無功能性腺癌直徑均較大(毬狀帶為4.3 cm和4.0 cm,束狀帶為7.1 cm和8.0 cm),癌細胞異形明顯併伴較多齣血、壞死和包膜、脈管侵犯.功能性腎上腺皮質毬、束、網狀帶的增生、腺瘤中臨床Conn、庫訢或生殖器綜閤徵伴有高血壓癥狀比例明顯高于不伴有高血壓組或僅有單純高血壓癥狀組,但病變體積沒有明顯差異.其中功能性毬、束狀帶腺瘤略小于無功能性,直徑分彆為1.7、2.3和2.3、2.4 cm,毬狀帶腺瘤平均直徑小于束狀帶.查體髮現的無功能性毬、束狀帶腺瘤的直徑大于非內分泌癥狀者(2.5、2.0和2.5、2.3 cm).伴生殖器綜閤徵患者7例(男2例,女5例),其中束狀帶腺瘤4例、腺癌1例,網狀帶增生、腺瘤各1例. 結論 遺傳學改變在腎上腺皮質疾病髮生中具有重要作用,而環境因素對其髮病趨勢變化的影響相對較弱.影像學檢查已作為腎上腺皮質疾病的首選定位檢查方法,對評價腫瘤良、噁性有一定提示作用.腎上腺皮質疾病臨床錶現與病理變化密切相關,確切的病變類型和腫瘤性質仍要由病理學檢查確定.
목적 탐토신상선피질질병급신상선피질구상대、속상대화망상대증생、선류、선암적림상병이학특점급상호관계. 방법 천진의과대학총의원병이과1993 - 2008년외과병리검사총수167 702례,기중신상선질병910례(0.54％)、신상선피질질병631례(0.38％).대검출솔、구성비、평균진단년령、성별비례급림상표현、병리변화진행통계학분석. 결과 신상선피질구상대、속상대、망상대병변분별위310례(49.13％)、319례(50.55％)、2례(0.32％).16년중신상선질병、신상선피질질병검출솔화신상선피질구、속상대질병구성비급각대증생、선류、선암적구성비균무변화추세,균표현위선류＞증생＞선암적발병규률.구、속、망상대공능성병변( 90.97％、79.00％、100.00％)명현고우무공능성병변(9.03％、21.00％、0％),병균이녀성다견.무공능성구상대선류、선암화속상대증생、선류적평균발병년령분별고우공능성병변.구상대선암적발병년령(62.7세)명현고우증생(47.8세)、선류(44.8세)；속상대선암평균년령화남성평균년령(44.3세,50.0세)분별고우선류(44.0세,49.1세)、증생(41.5세,40.9세),이녀성평균년령(38.7세)명현저우선류(42.4세)、증생(41.9세),무공능성선암발병년령최저(34.4세).공능성화무공능성선암직경균교대(구상대위4.3 cm화4.0 cm,속상대위7.1 cm화8.0 cm),암세포이형명현병반교다출혈、배사화포막、맥관침범.공능성신상선피질구、속、망상대적증생、선류중림상Conn、고흔혹생식기종합정반유고혈압증상비례명현고우불반유고혈압조혹부유단순고혈압증상조,단병변체적몰유명현차이.기중공능성구、속상대선류략소우무공능성,직경분별위1.7、2.3화2.3、2.4 cm,구상대선류평균직경소우속상대.사체발현적무공능성구、속상대선류적직경대우비내분비증상자(2.5、2.0화2.5、2.3 cm).반생식기종합정환자7례(남2례,녀5례),기중속상대선류4례、선암1례,망상대증생、선류각1례. 결론 유전학개변재신상선피질질병발생중구유중요작용,이배경인소대기발병추세변화적영향상대교약.영상학검사이작위신상선피질질병적수선정위검사방법,대평개종류량、악성유일정제시작용.신상선피질질병림상표현여병리변화밀절상관,학절적병변류형화종류성질잉요유병이학검사학정.
Objective To investigate the correlationship between clinical and histopathological results of adrenocortical hyperplasia,adenoma and adenocarcinoma in the adrenocortical glomerular,fascicular and reticular zones. Methods A total number of 167 702 surgical specimens were collected by the Department of pathology at the General Hospital of Tianjin Medical University from 1993 -2008.Of these,there were 631 adrenocortical specimens.Statistic analysis was done with Run test,t or t'test and x2 test on data in the aspects of proportion rate,mean age,sex proportion and relationship between clinical and pathological results of adrenocortical diseases. Results The total number of adrenal diseases and adrenocortical diseases were 910 cases (0.54％) and 631 cases (0.38％),respectively.The number of adrenocortical glomerular,fascicular,reticular diseases were 310 cases (49.13％),319 cases (50.55％) and 2 cases (0.32％),respectively.The rate of adrenal diseases and adrenocortical diseases specimens did not change during the 16 year study period.The trend in proportion of hyperplasia,adenoma,adenocarcinoma in adrenocortical glomerular,fascicular and reticular zones did not change as well.The proportion pattern showed that there were more cases of adenoma than of hyperplasia and adenocarcinoma.The functional diseases of adrenocortical glomerular,fascicular and reticular zone (90.97％,79.00％,100.00％ ) were higher than nonfunctional diseases in the corresponding zones (9.03％,21.00％,0％ ) and both were higher in female patients.The mean age of nonfunctional patients with adenoma,glomerular zone adenocarcinoma and hyperplasia,adenoma of fascicular zone was higher than that in functional diseases.Interestingly,the mean age of glomerular zone adenocarcinoma patients (62.7 yrs) was higher than that in hyperplasia patients (47.8 yrs) and in adenoma patients (44.8 yrs).The mean and male diagnostic ages of adenocarcinoma of fascicular (44.3 yrs,50.0 yra) were higher than that in adenoma (44.0 yrs,49.1 yrs) and hyperplasia (41.5 yrs,40.9 yrs) respectively.But the female mean diagnostic age of fascicular adenocarcinoma (38.7 yrs) was lower than that in adenoma (42.4 yrs) and hyperplasia (41.9 yrs) respectively and the lowest average age was for nonfunctional adenocarcinoma (34.4 yrs).The diameters of the functional and nonfunctional adenocarcinoma were large (4.3 cm and 4.0 cm in glomerular zone,7.1 cm and 8.0 cm in fascicular zone).The carcinoma cells were in serious atyrpia,haemorrhage,necrosis and capsular or vascular infiltration.The rates of functional hyperplasia,adenoma with hypertension in Conn,Cushing or adrenogenital syndrome of adrenocortical glomerular,fascicular,reticular zone were higher than that without hypertension,but their tumor diameters were similar.The diameters of functional adenoma in glomerular or fascicularer ( 1.7 cm,2.3 cm ) were lower than that of nonfunctional adenoma (2.3 cm,2.4 cm ) and the diameters of glomerular tumors were smaller than that of fascicular tumors.Nonfunctional adenoma ( 2.5 cm,2.0 cm ) of glomerular or fascicular by check up finding were bigger than that of non-endocrine adenoma ( 2.5 cm,2.3cm).There were seven cases with adrenogenital syndrome (2 male cases,5 female cases ),among these,there were 4 fascicularer adenoma cases,1 adenocarcinoma case,1 network hyperplasia case and 1 adenoma case. Conclusions Genetic abnormality plays an important role in pathogenesis of adrenocortical disease and environment had less influence.Radiological examinations (CT and MRI) of adrenocortical diseases are the first choice and have important roles in evaluating tumor characteristics.There is close relationship between clinical manifestation and pathology.However,the exact diagnosis of definite type of disease and nature of tumor needs to be made by pathologic examination.
