부신 우연종(adrenal incidentaloma)으로 진단된 부신 낭성 종양 고주파열치료 증례 1예

이진혁(Lee jin-hyeok),진미경(Jin mi-kyeong),정양화(Jeong yang-hwa) 대한초음파의료영상학회 2022 대한초음파의료영상학회 학술대회 초록집 Vol.6 No.1

개요 : 부신 우연종(adrenal incidentaloma)은 부신 질환을 의심할 만한 임상증상 없이, 다른 이유로 시행한 영상 검사에서 우연히 발견된 1cm 이상의 부신 종양을 말한다. 그 중에서도 부신 낭종의 발생률은 약 0.06~0.18%로 드문 질환이다. 모든 연령에서 발생할 수 있으나, 주로 40~60대에서 발생하며 남녀 비는 1:3으로 알려져 있다. 90%에서 일측성이며 대부분은 크기가 10cm 이하로 무증상이나, 50cm 이상의 큰 낭종이 발견되기도 한다. 부신 낭종이 발견되는 경우에는 일반적으로 수술적 절제술을 시행하여 악성유무를 판별하는 것이 중요한 것으로 알려져 왔다. 그러나 부신 낭종의 약 7%만이 악성이거나 악성화 가능성이 있으므로 환자가 연약하거나 수술을 원하지 않을 경우, 영상검사에서 양성의 소견을 보이고 호르몬 검사에서 비기능성인 경우에는 부신을 적출하지 않고 배액만 하는 방법도 제시되고 있다. 수술에 비해 부신에 인접한 신장, 폐, 췌장 등 정상조직에 피해가 적고, 출혈이나 감염 등의 합병증 발생 가능성이 낮다. 본 증례에서는 초음파 유도 하 고주파열치료와 배액술을 동반하여 부신 낭종을 치료하는 시술법을 통한 성공적인 시술 사례를 보고하고자 한다. 증례 : 환자는 61세 남성으로 5년 전 초음파상 우측 부신에 3.5cm의 낭종이 발견되었고, 2018년 5.9cm가량으로 크기 증가하여 수술여부를 환자가 선택하라고 들었으나 수술하지 않고 지내다 2021.01 CT상 7cm로 크기 증가하여 수술을 권유 받아 내원하였다. 기능성 부신 종양의 가능성을 배제하기 위하여 시행한 24시간 소변의 바닐만데릭산(vanillymandelic acid, VMA)과 메타네프린 검사, 혈청의 부신피질자극호르몬(ACTH), 그리고 코르티졸, 알도스테론 수치는 정상이었다. 과거력은 고혈압과 고지혈증이 있었으며, 가족력과 수술 경력은 없었다. 초음파 검사상 right adrenal gland에 septated cystic lesion이 보이며 septum에 의해 3개의 chamber로 분리되어 있고, septal wall calcification을 동반하고 있었다. 이에 MRI 검사 후 양성 낭종으로 판단되어 고주파열치료를 시행하기로 했다. 병변에 대해 18G Westcott needle을 이용하여 110ml의 노르스름한 장액혈액을 배액한 후 팁 길이 조절 가능한 17G proteus electrode를 이용하여 16분간 고주파열치료를 시행했다. 시술 직후 시행한 CT검사에서 지난 MRI과 비교하여 낭종의 크기가 4.1cm로 현저히 작아졌다. 퇴원 3개월 후 시행한 CT에서는 2.7cm로 더욱 작아진 것을 확인할 수 있었다. 이후 정기적인 혈액검사와 CT검사로 추적조사 중이다. 결론 : 경피적 배액술과 고주파열치료를 병행하는 시술은 단순한 낭종에 대한 효과적인 치료법이다. 특히, 연약한 환자나 수술을 원하지 않는 환자에게 수술 대안 방법으로 유용할 것으로 생각된다. Introduction : Adrenal incidentaloma refers to an adrenal tumor of 1cm or larger that is incidentally discovered on imaging tests performed for other reasons without clinical symptoms. Among them, the incidence rate of adrenal cysts is about 0.06 to 0.18%, which is a rare disease. It can occur at any age, but it mainly occurs in the 40s to 60s, and the male to female ratio is known to be 1:3. It is unilateral in 90% of cases, and most are asymptomatic with a size of less than 10cm, but large cysts greater than 50cm are sometimes found. When an adrenal cyst is found, it has been known to be important to determine whether it is malignant by performing surgical resection in general. However, only about 7% of adrenal cysts are malignant or potentially malignant, so if the patient is frail or does not want surgery, if the imaging test shows a positive result and the hormone test is non-functional, a method of draining only without removing the adrenal glands has been suggested. Compared to surgery, there is less damage to normal tissues such as the kidney, lung, and pancreas adjacent to the adrenal gland, and the possibility of complications such as bleeding or infection is low. In this case, we report a successful procedure to treat adrenal cyst using ultrasound-guided radiofrequency ablation and drainage. Case presentation : A 61-year-old male patient was diagnosed with a 3.5cm cyst in the right adrenal gland on ultrasound 5 years ago, and in 2018, the size increased to about 5.9cm, and the patient told to choose whether to have surgery, but after not undergoing surgery, the size increased to 7cm on a CT scan on 2021.01 and surgery was recommended. To rule out the possibility of a functional adrenal tumor, 24-hour urine vanillymandelic acid(VMA) and metanephrine tests, serum adrenocorticotropic hormone(ACTH), cortisol, and aldosterone levels were normal. There was a history of hypertension and hyperlipidemia, and there was no family history or surgical history. On ultrasound examination, a septated cystic lesion was seen in the right adrenal gland, separated into three chambers by a septum, and accompanied by septal wall calcification. Therefore, after an MRI scan, it was determined that the cyst was benign and radiofrequency ablation was performed. For the lesion, 110 ml of serosanguineous yellowish-colored fluid was drained using an 18G Westcott needle, and RFA was performed for 16 minutes using a 17G proteus electrode with adjustable active tip. In CT scan performed immediately after the procedure, the size of the cyst was significantly reduced to 4.1cm compared to the previous MRI. A CT scan performed 3 months after discharge confirmed that is was even smaller to 2.7cm. Since then, regular blood tests and CT scans have been carried out for follow-up. Conclusion : A combination of percutaneous drainage and radiofrequency ablation is an effective treatment for simple cysts. In particular, it is thought to be useful as an alternative to surgery for patients who are weak or do not want surgery.

진단 및 치료 목적으로 선형 내시경초음파 유도하 세침흡인술을 시행한 부신낭종 2예

김형훈,이정환,이상렬,이수연,박영일,류수형,김유선,문정섭 대한소화기내시경학회 2010 Clinical Endoscopy Vol.40 No.2

Adrenal cyst is a rare disease and its incidence rate is about 0.06∼0.18%. Many cases of adrenal cysts are diagnosed incidentally. Surgical excision is generally performed to rule out malignancy when an adrenal cyst is detected. However, a reviewing the overall cases revealed that only 7% of adrenal cysts were malignant or potentially malignant. Thus, it has been suggested to observe an asymptomatic simple benign cyst after aspiration. From this point of view, it is necessary to perform a functional hormonal test and fine needle aspiration cytology for investigating the nature of adrenal cysts. Adrenal cyst drainage can be performed when surgical resection is not indicated. Computed tomography or ultrasonography guided percutaneous aspiration and drainage has been performed, but linear endoscopic ultrasound has not yet been used for this purpose. We have performed endoscopic ultrasound guided fine needle aspiration of adrenal cysts for cytologic and hormonal examination and endoscopic ultrasound guided adrenal cyst drainage, and we report here on our experiences with this technique. 부신낭종은 드문 질환으로 약 0.06∼0.18%의 발병률을 보이며 우연히 발견되는 경우가 많다. 부신낭종이 발견될 경우 악성병변의 유무를 판별하기 위하여 수술적 절제술이 권고되어 왔으나 보고에 의하면 7%의 부신낭종만이 악성이었거나 악성화 가능성을 내포하고 있어서 무증상인 단순 양성 낭종의 경우 낭액 흡인 후 추적관찰 만으로 관리할 수 있다는 의견도 제시되고 있다. 이러한 관점에서 보면, 부신낭종의 성격을 규명하기 위하여 호르몬 검사와 낭액의 세포검사를 반드시 시행하여야 한다. 수술적 절제가 곤란한 경우는 낭종의 배액을 시행할 수 있으며 일반적으로 전산화단층촬영이나 초음파촬영술 유도하에 경피적으로 시행되어 왔으나 EUS-FNA를 시행한 경우는 없었다. 저자들은 EUS-FNA를 이용하여 부신낭종의 낭액을 흡인하여 세포검사와 호르몬 검사 등을 할 수 있었고 더 나아가 배액을 시행한 새로운 증례를 경험하여 문헌 고찰과 함께 보고 한다.

췌장의 점액성 낭종으로 오인된 부신 가성 낭종: 1예

김가정,송유정,문형곤,정상호,정치영,주영태,정은정,이영준,최상경,하우송,박순태,홍순찬,Ka-Jeong Kim,M,D,Yu-Jeong Song,M,D,Hyung-Gon Moon,M,D,Sang-Ho Jeong,M,D,Chi-Young Jeong,M,D,Young-Tae Ju,M,D,Eun-Jung Jung,M,D,Young-Joon Lee,M,D,Sang-K 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.1

Adrenal cysts are a relatively uncommon disorder and most such cases are discovered at autopsy. According to the overseas cases, the reported incidence is 0.06∼0.18% and the incidence is increasing due to the widespread use of ultrasonography and computed tomography scanning. Adrenal cysts are usually asymptomatic and they need to be differentiated from other cystic lesions including liver, pancreas and kidney cystic lesions. We report here on a case of a 39-year-old female with an adrenal pseudocyst that was misdiagnosed preoperatively as a pancreas mucinous cystic neoplasm. (Korean J Endocrine Surg 2009;9: 30-32)

부신의 기능성종양 및 비기능성 부신피질선종을 제외한 부신 양성종양에 대한 임상적 고찰

김성훈,이준호,김지수,최준호,남석진,이정언,김석원,길원호,김정한,Sung Hun Kim,Jun Ho Lee,Jee Soo Kim,Jun-Ho Choi,Seok-Jin Nam,Jeong-Eon Lee,Seok Won Kim,Won Ho Kil,Jung-Han Kim 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.4

Purpose: Benign adrenal tumors other than hyper-functioning tumor and non-functioning cortical adenoma are extremely rare. The purpose of this study is to review the clinical features of these rare benign adrenal tumors and to analyze their prevalence and the proper surgical approach for them. Methods: Among patients who underwent adrenalectomy in Samsung Medical Center, between 1997 and 2013, patients with benign adrenal tumor except non-functioning cortical adenoma, malignancy, and hyper-functioning tumor such as pheochromocytoma, aldosteronoma, and cortisol producing tumor were included. Clinical details, radiologic findings and pathologic findings as well as data associated with the surgical procedure were analyzed retrospectively. Results: The percentage of these tumors among 703 surgically removed adrenal tumors was 10.7% (75 cases). They included 30 adrenal cysts, 18 ganglioneuromas, 11 myelolipomas, seven schwannomas, and the other six were rare adrenal tumors. Approximately 40% of the patients were operated under a diagnosis different from original tumors. Operation time and hospital stay of patients who underwent laparoscopic adrenalectomy were shorter than those of patients who underwent open adrenalectomy. Conclusion: These benign adrenal tumors are very rare and difficult to diagnose preoperatively. For the surgical treatment of these tumors, laparoscopic adrenalectomy is more preferable to conventional open adrenalectomy.

수술 전 간내 담관 낭선종으로 오인된 부신 낭종의 복강경적 절제술

박지훈(Ji Hoon Park),고대경(Dae Gyoung Ko),최인석(In Seok Choi),윤대성(Dea Sung Yoon),최원준(Won Joon Choi) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.5

Adrenal cysts are a rare disease, and its prevalence is reported to be 0.06∼0.18%. Its frequency of being recognized is increasing due to the widespread use of ultrasonography and computed tomography (CT) scans. We report here on a case of adrenal cyst that was mistaken as biliary cystadenoma prior to operation due to its location and features. Laparoscopic exploration was performed via the transabdominal approach and this revealed a right adrenal cystic mass in the retroperitoneum beneath the liver (segment Ⅳ). We present here a case of adrenal cyst with endothelial lining along with a review of the literature to address the clinical presentation, histology, imaging features and differential diagnosis of this interesting and rare entity.

산전 진단된 신경아세포종 1 예

이정기(Jeong Ki Lee),이은주(Eun Ju Lee),홍승표(Seung Pyo Hong),김지훈(Ji Hoon Kim),최운민(Woon Min Choi),민기옥(Ki Oak Min),문희봉(Hee Bong Moon),김흥기(Heung Ki Kim),김창이(Chang Yee Kim),고영미(Young Me Koh) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

We report a case that a neuroblastoma in a fetus was recognized before birth and its growth could be observed. The diagnosis was made by ultrasonography. The suprarenal mass initially showed pure cystic features on ultrasound. Surgical exploration revealed an adrenal cystic tumor and histology showed a neuroblastoma in situ. Forty-five infants with prenatally detected neuroblastoma were found in the English literature; about one-half of them were cystic neuroblastomas and most had a favorable outcome.