J.Jpn. Surg. Soc.. 61(9): 1145-1169, 1960
宿題報告
TUMORS OF THE ADRENAL
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Department of Surgery, Gunma University Medical School K. SHIBUSAWA |
I. Adrenal findings in cancer carriers of other organs.
About 6 % of cancer patients show the hyperfunction of the adrenal, both histologically and clinically, without adrenal metastasis. Such adrenal hyperactivity is found mainly in the corticometabolic disorder, for instance, 7% of total cases of the Cushing's syndrome are based on the cancer of other organs and are not of the adrenal origin.
II. Nonhormonal tumors of the adrenal.
One case of adrenal melanoma, which stimulated the function of the adrenal cortex in its late course, and one case of adrenal carcinoma without any stimulation were reported. Because of lack of adrenal symptoms, nonhormonal tumors grow to large masses, and are found too late to attain the good operative result.
III. Corticometabolic tumors.
1. Aldosteronism.
Primary aldosteronism rests chiefly on the small adenoma in adult, and rarely on the adrenal hyperplasia in infant. Signs and symptoms, such as hypertension, increased output of potassium, hypopotassemia, alkalosis and muscle paralysis, and the electrocardiographic changes are its characteristic feature, which makes it distinguishable from other hyperadrenocorticism. Operative cure is expected in 90% cases.
2. Cushing's syndrome.
One third consists of adrenal tumors and the other of adrenal hyperplasia, which is relatively small in weight. Tumor is found usually on one side and the unilateral adrenal reveals a striking atrophy. Clinical features are so characteristic that are never mistaken for other hyperadrenocorticism. Hyperplasia responds remarkably to ACTH-test, cancer does not respond, and one third of adenoma shows some response; from this point of steroids output adrenal structure wil be judged before operation. In fulminating cases total adrenalectomy wil be pertinent, and in older patients with hypertensive damages of the heart, kidney and brain subtotal adrenalectomy or unilateral adrenalectomy accompanied by pituitary irradiation wil be urged. Operative cure wil be expected in 80% of hyperplasia and adenoma, and in 50% of cancer.
IV. Corticosexual tumors.
1. Virilizing tumor.
The majority of tumor is cancer found in girl, in which unilateral atrophy of the adrenal is rare. Metabolic changes are mild and rare; highly increased excretion of 17 KS, particularly of their fl fractions, is the remarkable finding discriminating from other hyperadrenocorticism. Because of the malignancy of the tumor, operative curability is unexpectedly poor.
2. Feminizing tumor.
It consists in cancer attacking adult male. As the clinical feature, gynecomastia in solely remarked, so that the revelation is too belated to obtain the good operative result. One case of adrenal feminization due to undifferentiated bronchogenic cancer is reported.
V. Neuroblastoma.
Sympathicogonioma, sympathicoblastoma and ganglioneuroblastoma are found in the adrenal of childhood under 3 years of age. Pepper type attacks mainly infant under 1 year, and has more favourable prognosis, for instance, the spontaneous maturing or healing is observed. Hutchison type is found in infant under 3 years and it prognosis is very discouraging showing canceremia, protrusion of the eye ball and osseus metastasis. Operative cure is expected only in Pepper type under 1 year of age without metastasis.
VI. Adrenal findings in hypertensive patients.
Increase in the adrenal weight, and frequent appears of the adrenal hyperplasia and cortical nodules are observed in the necropsy of the hypertensive patient of 120~130 mmHg of diastolic pressure. In such hypertension, average excretion of aldosterone in increased, and the production of 17 OHCS is animated. And we can find frequently a diffuse or nodulous hyperplasia of the adrenal niedulla which shows an increased excretion of catecholamines responding to nicotine tartarate.
VII. Pheochromocytoma.
Intraadrenal pheochromocytoma consists of two sorts of cells, one chromaffine and the other periodic-acid-stained, and consequently shows the increased excretion of adrenaline and noradrenaline. Extradrenal tumor is found in 10% of total cases and showssolely the increased excretion of noradrenaline. In the former one can find metabolic changes besides hypertension, in the latter contrarily hypertension is the sole finding. Pheochromacytoma is complicated by manifold tumors or malformations, particularly by neurofibromatosis and other neurocutaneous manifestations. Malignancy may be found in 10%- Operative risk is based chiefly on the extreme changes in blood pressure and heart failure. Operative mortality is under 10%.
(Author's abstract)
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