褐色細胞腫19例の臨床的検討

Abstract

1979～1990年の間に本症19例(男9例)を経験し, 平均42.4歳であった.18例で腫瘍は副腎(右側9例, 左側5例, 両側4例)に局在したのに対し, 最初の腫瘍が15年前に摘出されていた1例では副腎外に再発し, 組織学的に悪性褐色細胞腫と判明し, 摘出した.高血圧は16例にみられ, 発作性14例, 持続性2例であった.家族性褐色細胞腫は5例にみられた.3例はSipple症候群を有した.術前の腫瘍局在診断上CT及びMRIは非常に有用な方法であった.術前α或いはβ遮断薬治療例でも腫瘍摘出直後に有意の低血圧が起り, ノルエピネフリン投与, 急速輸血, 或いは両者を必要とした

Nineteen cases of pheochromocytoma were experienced at our department between 1979 and 1990. Nine patients were males and 10 females with an average of 42.4 years old. In 18 patients the tumor was located in the adrenal gland (9 in right, 5 in left and 4 in bilateral adrenal gland), while in one patient whose original tumor had been resected 15 years earlier, the tumor had recurred in the extra-adrenal gland and was surgically extirpated revealing a malignant pheochromocytoma by histological examination. Hypertension was seen in 16 patients; 14 had paroxysmal and 2 had sustained hypertension. In 3 patients, hypertension was not observed. Familial pheochromocytoma was seen in 5 patients. Three patients had Sipple syndrome. Computed tomographic scan and magnetic resonance imaging were very useful techniques in preoperatively localizing the tumor. Even in the cases treated with alpha- or beta-blocker agents preoperatively, significant hypotension was observed immediately after resection of the tumor and treatment with norepinephrine or rapid blood transfusion or both was needed. Although meticulous care with alpha- and beta-blockers is important, surgical treatment of pheochromocytoma should spare the surgeon of unnecessary anxiety.