経皮的副腎腫瘍生検により診断し保存的に経過観察した副腎骨髄脂肪腫の2例

Abstract

症例1, 39歳男.腹痛を主訴とし超音波で右副腎腫瘍を指摘され入院した.右腎上極に接して高エコー像を呈する腫瘍(4×4×3cm)を認めた.症例2, 64歳男.夜間頻尿を主訴としてDIPで左腎上部に占拠性病変を認め入院.左腎上局に接して高エコー腫瘍(5×4.5×4cm)を認めた.内分泌学的検査及び画像所見から2症例共副腎骨髄脂肪腫が疑われ, 経皮的副腎腫瘍生検を行い, 成熟脂肪細胞の中に骨髄造血細胞が散在性に認められ, 副腎骨髄脂肪腫の確定診断を得た

We report 2 cases of adrenal myelolipoma which were diagnosed definitively by ultrasonically guided percutaneous biopsy to waive surgery. In case 1, a 39-year-old man presented with abdominal pain. A right adrenal mass was detected by abdominal ultrasonography. In case 2, a 64-year-old man presented with nocturia. A space-occupying lesion above the left kidney was detected by excretory pyelography. Both cases were suspected of adrenal myelolipoma by ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). The tumor size was 4 x 4 x 3 cm and 5 x 4.5 x 4 cm in cases land 2, respectively. In both cases percutaneous needle biopsy using ultrasonically guided puncture was performed. Histology showed a complex of hematopoietic and adipose tissues, corresponding to adrenal myelolipoma. The course has been uneventful without surgery for 58 months and 24 months, respectively. Percutaneous adrenal biopsy was useful to establish the definitive diagnosis and to select treatment options.