特発性副腎血腫の1例

Abstract

63歳女.B型肝炎の加療中に超音波断層検査で副腎腫瘍が疑われたが, 無症状であった.Gd-DTPA MRIにて内部が造影されず嚢胞状の腫瘤が認められ, その他画像所見, 血液内分泌検査より副腎血腫, 内分泌非機能性腫瘍が疑われた.CTでの経過観察を考慮したが, 患者の希望で腹腔鏡下右副腎摘除術を施行した.病理組織学的所見から, 腫瘤はコレステリン結晶を伴った陳旧性の出血巣で, 硝子様の結合織からなる被膜が認められ, 明らかな腫瘍性病変は認められず, 副腎血腫と診断された.副腎皮質細胞の集塊が残存していることから副腎髄質からの出血が考えられた.術後経過良好である.突発性副腎血腫の報告は日本で13例あった

We report a rare case of idiopathic adrenal hematoma. Including our case, 13 such cases have been described in Japan. A 63-year-old [correction of 65] woman was admitted to our hospital for further examination of a right adrenal mass on ultrasonography. Laboratory tests including hormonal assay were within the normal ranges. Computed tomography showed a tumor with calcification measuring 3.0 x 2.0 cm in the right adrenal gland. Magnetic resonance imaging (MRI) revealed a mass with heterogeneous low to iso signal intensity on T1-weighted images and high signal intensity on T2-weighted images. A peripheral rim of the mass was slightly enhanced on dynamic MRI. The patient underwent laparoscopic adrenalectomy. Histopathological examination revealed an old hematoma without neoplastic cells or vascular lesions and these findings were evidence of idiopathic adrenal hematoma.