特殊案例報告: 腎上腺碰撞腫瘤

蘇奕瑋、賴昱維、薛又仁、黃建榮、蕭毅君、李淑文、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科

A case report: Adrenal collision tumor

Yi-Wei Su, Yu-Wei Lai, Thomas Y. Hsueh, Andy C. Huang, Yi-Chun Hsiao, Shu-Wen Li, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction:

Collision tumor is defined as a neoplastic lesion with two or more histologic distinct cell population with clear border. Although adrenal gland composed of three zones (zona glomerulosa, zona fasciculata and zona reticularis), collision tumor at adrenal gland is still a rare condition and fewly reported around the world. Most of the adrenal tumors are found incidentally and asymptomatically. However, the symptoms may be seen in some cases and variate depend on different pathophysiology. We presented a 55-year-old man who had collision tumor of adrenal gland and underwent robotic-assisted laparoscopic adrenalectomy.

Case presentation: 

A 55-year-old man who had no systemic past medical history. He underwent regular health examination and low dose chest CT revealed a left adrenal tumor. He was then referred to urology OPD. For more precise image, abdominal CT was then performed which disclosed left adrenal collision tumor with a 6.0cm left adrenal tumor with the differential diagnosis of adrenocortical carcinoma, pheochromocytoma and a 4.0cm left adrenal tumor with the differential diagnosis of myelolipoma, adenoma. Biochemistry examination found elevated ACTH and declined cortisol level. Besides, elevated aldosterone and renin were found. However, 24hr cortisol level in urine was in normal range. Robotic-assisted laparoscopic adrenalectomy was arranged and the tumor was removed. He was transferred to intensive care unit (ICU) after the surgery and transferred back to ordinary ward one day later after extubation. The postoperative course was smooth at first but fever with abdominal pain was complained after 1 week. Pancreatic injury and acute cholecystitis were both found. His symptoms improved under conservative medical treatment including hydration, NPO and antibiotics use. Pathologic report disclosed two histologic parts: 1. adrenal cortical adenoma with infarction 2. myelolipoma. Collision tumor was diagnosed. He was discharged after restart oral diet and further followed up at outpatient department. (OPD)

Conclusion:

        Collision tumor at adrenal tumor rarely happens and is reported sporadically. Comprehensive image and biochemistry study are essential for further treatment. For small and nonsymptomatic adrenal tumors, observation is the first option. For symptomatic or over 4cm adrenal tumor, surgical resection is the standard treatment. Postoperative follow up is important and suggested for every patient.