1. Cortisolism mainly includes a group of clinical manifestations caused by chronic glucocorticoid increase: full moon face, buffalo back, centripetal obesity, hirsutism, diabetes tendency, sexual dysfunction, menstrual disorder and oligozoospermia. It should be noted that more than half of children are caused by cancer, and the feminization of women or men is obvious, which also suggests the possibility of cancer.
2. Primary aldosteronism has gradually increased blood pressure, poor antihypertensive effect, hypokalemia and alkalosis (myasthenia, muscle paralysis, arrhythmia, tetany, painful muscle spasm, etc. ).
3. Adrenal pheochromocytoma releases a lot of adrenaline and norepinephrine, which can cause vasoconstriction and rapid heartbeat, thus causing paroxysmal hypertension, accompanied by severe headache, pale skin, especially pale face, rapid heartbeat, tremor of limbs and head, sweating, fatigue, and sometimes chest tightness, shortness of breath, nausea and vomiting.
4. Non-functional tumors include metastases, hematomas and cysts.
I. Overview
Tumors occurring in adrenal gland are adrenal carcinoma, which can be divided into adrenocortical adenoma, adrenocortical carcinoma and adrenal medullary tumor.
The adrenal gland is a gland located above the kidney. Like the kidney, there are two adrenal glands, one on the left and the other on the right, above the retroperitoneal kidney. The left adrenal gland is half-moon, and the spleen is adjacent to it. The right adrenal gland is triangular and the liver is adjacent to it. Adrenal gland is a very important and indispensable endocrine organ of human body. It can secrete four categories and dozens of hormones, which are delivered to various tissues and organs of the human body through blood circulation and play its specific physiological role.
Second, pathology.
The adrenal cortex is located in the side of the adrenal gland and surrounds the medulla. The volume of cortex accounts for about 90% of the whole adrenal gland. It is divided into three layers from the outside to the inside, and the outermost layer is spherical, accounting for about15% of the whole cortex; The middle layer is fascicular zone, the thickest, accounting for about 78% of the whole cortex; The inner layer is reticular zone, which accounts for only 7% of the cortex and is the thinnest.
Adrenal medulla is in the middle of adrenal gland, accounting for only about 10% of adrenal gland. Medullary cells have different shapes. Because the particles in marrow cells can be colored after being treated with chromium-containing liquid, they are called chromaffin cells.
There are four kinds of endocrine cells in adrenal cortex and medulla, which secrete different hormones and shoulder different missions in this small world.
(1) adrenocortical adenoma
Adrenal cortical adenomas are similar to focal nodular hyperplasia, and they can be complicated. Adenoma is usually unilateral and single, with thin capsule and compression on surrounding tissues, which is the key point of differentiation. The size and diameter are 1 ~ 5 cm, and the section is yellow and sometimes reddish brown. Microscopically, most of them are foam-like transparent cells similar to fiber bundles, which are rich in lipids, sometimes composed of eosinophils with low lipid content, or mixed with two kinds of cells. Tumor cells are arranged in clusters and separated by a small amount of matrix containing capillaries. Some adenomas are functional, which can cause aldosteronism or Cushing's syndrome, and there is no difference in morphology from non-functional adenomas. (2) Adrenal cortical carcinoma
Adrenal cortical carcinoma is rare and usually functional. When found, it is generally larger than adenoma, and its weight often exceeds 100g, showing invasive growth. Normal adrenal tissue is destroyed or submerged, and it will invade the surrounding adipose tissue and even the kidney. Small adenocarcinoma can have capsule. The section is brown, and bleeding, necrosis and cystic degeneration are common. Microscopically, those with poor differentiation have high atypia, tumor cells of different sizes, grotesque nuclei, multinuclei and mitotic images. Often transferred to abdominal aorta lymph nodes or blood flows to lungs, liver and other parts. Microscopically, well-differentiated people look like adenomas. If the cancer is small and encapsulated, it is difficult to distinguish it from adenoma. Some people think that well-differentiated adenocarcinoma should be considered if the diameter is greater than 3cm.
(3) Adrenal medullary tumor
Adrenal medulla is derived from neural crest, and the original cell is sympathetic neuroblastoma, and then differentiated into ganglion cells and pheochromocytoma, so neuroblastoma, ganglion cell tumor and pheochromocytoma can be formed.
Pheochromocytoma of adrenal medulla accounts for 80% ~ 90%, mostly unilateral and single, occasionally bilateral, 90% benign, mostly occurring in 30 ~ 50 years old. Tumor cells can secrete norepinephrine and epinephrine, mainly norepinephrine, and occasionally dopamine and other hormones. Therefore, there are mainly symptoms of high catecholamine in clinic, such as elevated blood pressure, intermittent attacks, accompanied by headache, sweating, peripheral vasoconstriction, accelerated pulse, elevated blood sugar and increased basal metabolism. Macroscopically, it varies in size, averaging about 100g, even reaching 2000g. It has capsule, grayish red and grayish brown sections, and common bleeding, necrosis, cystic degeneration and necrotic foci.
Microscopically, chromaffin cells are large polygonal cells, forming cell cords or cell nests, which can have different degrees of polymorphism, sometimes giant cells appear, and there are a large number of chromaffin fine particles in the cytoplasm of tumor cells. Under electron microscope, the particles were encapsulated, and those with low electron density contained epinephrine, while those with unclear envelope and high electron density contained norepinephrine, and immunohistochemistry could also show it. The stroma is mainly blood sinus. There is no clear boundary between benign and malignant tumor in cell morphology, and capsule invasion can not be used as positive evidence of malignancy, but if there is infiltration and metastasis of surrounding tissues, it is undoubtedly malignant.
Extraadrenal pheochromocytomas are mostly multiple, located in the distribution area of paragangliomas on both sides of aorta, and are often called paragangliomas. This kind of tumor usually occurs in 10 ~ 20 years old, which is mostly a part of multiple endocrine tumors, and 40% is malignant.
Third, symptoms
Tumors can occur in both adrenal cortex and medulla. Those that cause endocrine function variation are called functional tumors, and those that do not cause endocrine function changes are called non-functional tumors.
Aldosteronism is mainly caused by cortical adenoma. The main symptom is hypertension, which is generally moderately elevated. The second kind of symptoms are myasthenia or paralysis and paresthesia. The third symptom is polyuria, nocturia and polydipsia.
Cortisolism is mostly caused by adrenal cortex hyperplasia or tumor, which is characterized by full moon face, buffalo back, centripetal obesity, emaciation, blood color and purplish red limbs. Fatigue, fatigue, low back pain; Hypertension; Hairiness, alopecia, acne; Sexual dysfunction, amenorrhea or menorrhagia.
Abnormal gonads are caused by cortical tumors, which are divided into genital enlargement and precocious puberty, female pseudohermaphroditism and female masculinity.
The main symptoms of pheochromocytoma are hypertension and metabolic changes. Paroxysmal hypertension increases with palpitation, shortness of breath, headache, sweating, nervousness, chills and limb tremors.
Non-functional adrenal tumors mainly occur in interstitial cells of cortex or medulla, including non-functional cortical adenoma and adenocarcinoma, neuroblastoma and ganglion cell neuralgia.
Fourth, common treatment methods
Surgery is the only way to treat adrenocortical carcinoma at present. In addition, rocket cryotherapy, retroperitoneal laparoscopic surgery and argon-helium knife have also made some breakthroughs in the treatment of adrenal tumors.
Verb (abbreviation of verb) diffusion and transfer
The postoperative recurrence rate of adrenocortical carcinoma is high. It is reported that the average survival time of recurrent tumor after reoperation (15.814.9 months) is significantly longer than that of non-operative group (3.2 2.9 months). It is generally believed that cancer cells are difficult to be exposed during reoperation, there is the possibility of metastasis, and the probability of complete resection is very small, so the significance of reoperation is uncertain.
Prognosis of intransitive verbs
Adrenal cortical carcinoma has a high degree of malignancy and poor prognosis, and its natural course rarely exceeds 1 year.