背景:vonHippel-Lindau病(vHL病)是一种遗传性疾病,其中肿瘤和囊肿在许多器官中发展,与中枢神经系统血管母细胞瘤有关,嗜铬细胞瘤,和胰腺肿瘤.我们在此报告一例与双侧嗜铬细胞瘤相关的vHL病(2A型),胰腺神经内分泌肿瘤(PNET),肾上腺切除术后通过胰腺切除术治疗的小脑血管母细胞瘤。
方法:一名51岁的妇女出现小脑肿瘤,双侧高肾瘤,和在体检中发现的胰腺肿瘤。18F-氟代脱氧葡萄糖正电子发射断层扫描-计算机断层扫描显示双侧肾上腺肿瘤和胰头肿瘤,而腹部计算机断层扫描检查显示胰腺头部有一个30毫米的肿瘤,强烈增强。颅磁共振成像显示小脑血管母细胞瘤。因此,诊断为vHL病(2A型).她的家族史包括父亲的肾细胞癌和兄弟的双侧肾上腺嗜铬细胞瘤和脊髓血管母细胞瘤。对内分泌功能的详细检查表明,肾上腺肿块能够产生儿茶酚胺。嗜铬细胞瘤的治疗是优先考虑的,因此,进行了腹腔镜左肾上腺切除术和右肾上腺次全切除术。一旦术后类固醇水平得到补充,对PNET进行了保留胃的胰十二指肠切除术。经过良好的术后过程,患者在术后第11天缓解出院.组织病理学检查结果显示,在整个切除标本中,NETG2(MIB-1指数10-15%)pT3N0M0II期A和微囊性浆液性囊腺瘤。患者计划接受小脑血管母细胞瘤的治疗。
结论:对于与vHL疾病相关的双侧嗜铬细胞瘤和PNET,两阶段切除是一种安全有效的治疗选择。
BACKGROUND: von Hippel-Lindau disease (vHL disease) is a hereditary disease in which tumors and cysts develop in many organs, in association with central nervous system hemangioblastomas, pheochromocytomas, and pancreatic tumors. We herein report a case of vHL disease (type 2A) associated with bilateral pheochromocytomas, pancreatic neuroendocrine tumors (PNET), and cerebellar hemangioblastomas treated via pancreatectomy after adrenalectomy.
METHODS: A 51-year-old woman presented with a cerebellar tumor, bilateral hypernephroma, and pancreatic tumor detected during a medical checkup. 18F-fluorodeoxyglucose positron emission tomography-computed tomography revealed a bilateral adrenal gland tumor and a tumor in the head of the pancreas, while an abdominal computed tomography examination revealed a 30-mm tumor with strong enhancement in the head of the pancreas. Cranial magnetic resonance imaging showed a hemangioblastoma in the cerebellum. Therefore, a diagnosis of vHL disease (type 2A) was made. Her family medical history included renal cell carcinoma in her father and bilateral adrenal pheochromocytoma and spinal hemangioblastoma in her brother. A detailed examination of endocrine function showed that the adrenal mass was capable of producing catecholamine. Treatment of the pheochromocytoma was prioritized, and therefore, laparoscopic left adrenalectomy and subtotal resection of the right adrenal gland were performed. Once the postoperative steroid levels were replenished, subtotal stomach-preserving pancreatoduodenectomy was performed for the PNET. After a good postoperative course, the patient was discharged in remission on the 11th day following surgery. Histopathological examination findings indicated NET G2 (MIB-1 index 10-15%) pT3N0M0 Stage II A and microcystic serous cystadenoma throughout the resected specimen. The patient is scheduled to undergo treatment for the cerebellar hemangioblastoma.
CONCLUSIONS: A two-staged resection is a safe and effective treatment option for bilateral pheochromocytoma and PNET associated with vHL disease.