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患者男性,76岁,自述右上腹部疼痛不适3月余。体格检查未见明显阳性体征。实验室检查提示糖类抗原50、糖类抗原199、癌胚抗原水平均为正常。腹部CT平扫及增强扫描:胰腺体后方见一软组织肿块影,大小约为3.2 cm×5.0 cm,与胰腺分界清晰,病灶边缘清晰,密度不均匀,增强扫描后呈不均匀强化,考虑淋巴结肿大可能。B超检查提示胰腺后方见不均质包块伴高阻动脉血流,考虑恶性淋巴结可能。18F-FDG PET/CT(德国Siemens公司Biograph 16型)显像:常规肘静脉注射18F-FDG(剂量为0.74 MBq/kg,18F-FDG为本中心explora FDG 4模块合成,放化纯度>95%)后,休息60 min进行PET/CT显像,结果:胰体左后方占位,与胰腺及左侧肾上腺分界清晰,病灶最大标准化摄取值(maximum standardized uptake value,SUVmax)为4.1(图 1),约50 min后进行延迟显像,病灶代谢活性较前增高,SUVmax为5.2(图 2),全身PET/CT未见其他原发灶及转移灶,因此考虑为原发于腹膜后的恶性肿瘤的可能性大。
术中所见:腹腔内无腹水,盆腔、肠管、肝脏、胃、双侧肾上腺及胰腺等均未有明显异常,肿瘤位于左侧腹膜后、胰体后方、腹主动脉左侧、肠系膜下静脉后方,界限清楚,沿肿瘤周围仔细分离,完整切除肿块,术中触碰肿瘤时血压波动大,收缩压达200 mmHg(1 mmHg=0.133 kPa),考虑嗜铬细胞瘤的可能性大。病理诊断为腹膜后副神经节瘤,大小为5.0 cm×4.5 cm×2.5 cm(图 3)。免疫标记结果:嗜铬素、突触素、波形蛋白、S-100支持细胞和细胞增殖抗原标志物均为阳性,且<3%;细胞角蛋白和黑色素瘤标志物为阴性。
腹膜后副神经节瘤18F-FDG PET/CT显像1例
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关键词:
- 副神经节瘤 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 氟脱氧葡萄糖F18
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