1 case of imaging performance of adrenal melanoma
Last Update: 2020-06-16
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The case of the male, 49 years old, a medical examination found that the right adrenal area of the swelling, had a history of faintingDeny the history of chronic diseases such as "hypertension, coronary heart disease, diabetes" and so onBlood, urine catechol, blood cortisol, aldehyde ketone index is normalUpper abdominal CT (Figure 1): right adrenal region see about 4.9 cm x 2.9 cm oval low density shadow, boundary can be identified, density is uneven, see small flakes slightly high density shadow, flat sweep CT value 26.55HU, enhanced scanning disease The CT value in the oven is slightly continuously strengthened, the cortical period is 33.69HU, myelin period 33.35HU, the secretion period is 34HU, the tumor envelope myelin period is significantly enhanced, and the inner stout of the right adrenal gland is not clear, the lower cavity veins move forwardFigures 1a to 1d are axial flat sweep, cortical period, myelin period, secretion periodMRI (Figure 2): Compared with the liver, T2WI-FS shows significantly high signal lumps of the right adrenal gland, uneven internal signal, low signal ring at the edge, T1WI inversion phase, T1WI-FS tumor signal sharply reducedTumor excision under laparoscopic surgery, postoperative pathology (Figure 3): most of the right adrenal tumor saloons coagulation necrosis, peripheral fibrous tissue growth, wrapping, a large number of lipolicosin cells under the mirror, pathological diagnosis: right adrenal adenomaFigures 2a to 2d are axial T1WI inverted phase, T1WI phase, T2WI-FS, T1WI-FSFigure 3a, 3b Pathology: adrenal melanoma, right adrenal tumor most coagulation necrosis, peripheral fibrous tissue growth, wrapped, see a large number of liposomecells (HE)Discussing adrenal melanoma, also known as pigmented adrenal epitope adenoma, is a rare adrenal benign tumor, because the cells contain a large number of liposomes or melanin particles, the naked eye is black or brown, so clinically often referred to as melanoma or melanoma, mostly functional adenomaIts incidence rate of about 10% to 37%, clinical performance is not typical, some functional adenomas can have Cushing syndrome or primary aldosterone hyperplasiaThis case is no functional adenoma, occasional physical examination foundAdrenal melanoma imaging performance at present only a few reports at home and abroad, generally oval lumps, related literature reported as long oval, long diameter is 2 to 4 times short diameter, in morphology has certain characteristicsCT performance is equivalent or slightly low density lumps, the boundary is clear, there is a complete envelope, flat sweep CT value of about 30HU, similar to adjacent normal adrenal tissue, enhanced scanning is significantly uniform reinforcementMRI performance: compared with the liver, tumor T2WI is slightly higher signal, T1WI is equivalent or slightly lower signal, T1WI inversion and T1WI-FS sequence are not visible signal attenuation, indicating the lack of fat components in the tumor, with certain characteristicsThe literature reported that adrenal melanoma had no obvious intake on adrenal 131I-MIBG imaging, fDG-PET/CT was higher lying and specific than CT and MRI imaging, mainly in the early and delayed period of Increased FDG intake, and higher than the intake of the liver In this case, adrenal tumors and the main imaging manifestations of black adenomareporteds are generally consistent, but its reinforcement method is different from typical black adenomas, CT dynamic enhancement tumor is not significantly strengthened, MRI T1WI-FS, T2WI-FS show significantly high signal, signal uneven, T2WI edge low signal ring, all indicate the presence of solidified necrotic nematode seurased substances inside the tumor Adrenaline melanoma as a special type of adrenal adenoma, its coagulation necrosis mechanism is not clear, we think that mainly due to a large amount of lactin deposition, leading to a slow decline in tumor metabolism, activity decline until cell decline, part of the tumor ischemia, necrosis, is a long-term evolution of the chronic process with time Adrenal melanoma should be identified with the following tumors: (1) pigmented cytomegaloblastoma or cytomorphoma cystvariants: CT performance is usually larger, has a complete envelope, prone to necrosis cystic variation, tumor blood supply is rich, arterial period, vasculature lesions are more intensive than adenomas, and duration Longer; (2) other pigmentous tumors such as adrenal melanoma, adrenal metastatic melanoma: CT is a large uneven lump, center visible necrosis and bleeding, MRI is T1WI high signal, T2WI low signal, but still need to be combined with clinical and pathological, special staining and other identification In summary, adrenal melanoma is clinically rare, when imaging examination shows the adrenal long oval homogenous lump, has a complete envelope, flat sweep CT value of about 30HU, enhanced significantly, but this case is special; 1WI inversion/phase, T1WI-FS did not see significant signal attenuation, adrenal 131I-MIBG imaging on no significant intake, FDG-PET/CT early and delayed period ingestion higher than the liver, the possibility of adrenal melanoma need stake is considered
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