副腎神経節細胞腫の1例

Abstract

37歳男性.患者は健診で肝機能異常を指摘され, 近医のCTで右副腎腫瘍を疑われ紹介入院となった.所見では, 内分泌検査でアルドステロンの若干の高値を認め, CTでは右副腎に6.7×5.7cmの境界明瞭で内部に粗大な点状石灰化を含む分葉状腫瘤が認められた.また, MRIではT1強調で内部は均一な低信号で, 造影早期に隔壁様濃染を示し, 次第に濃染範囲は拡大し, T2強調では中～高信号で, 内部は隔壁様に低信号で境界されていた.内分泌非活性型右副腎腫瘍と診断し, 癒着・浸潤を懸念して開放手術による腫瘍摘出術を施行した.病理組織所見では, 腫瘍は副腎組織と融合し, 腫瘍本体内に副腎組織を認め, Schwann細胞および神経線維が主体で部分的に良く分化したganglion cellが混在しており, 副腎原発の神経節細胞腫と診断された.術後6ヵ月経過現在, 再発は認められていない

A patient with an incidentally diagnosed adrenal ganglioneuroma is reported. A 37-year-old man who underwent abdominal computed tomography (CT) in the course of evaluating liver dysfunction was found to have a right adrenal tumor. Laboratory data including results of endocrinologic tests were normal except for a slight elevation of plasma aldosterone. With a preoperative diagnosis of non-functioning right adrenal tumor, resection was performed. The tumor specimen was noncystic weighing 150 g and measuring 10 x 8 x 3 cm. The histopathologic diagnosis was ganglioneuroma originating from the adrenal gland. Adrenal ganglioneuroma is relatively rare, 147 cases including ours have been reported in Japan. Increasing numbers of these tumors are being found incidentally by ultrasonography or CT. Ganglioneuroma is a benign tumor, and disagreement exists concerning diagnosis and indications for surgery.