ﻲﻓﺮﻌﻣ 2
لﺎﻧردآ مﻮﭙﻴﻟﻮﻠﻴﻣ درﻮﻣ
يﺮﮕﺴﻋ نﺎﮔﮋﻣ ﺮﺘﻛد *
Iﺮﺘﻛد ﻲﻗاﺮﻋ دﻮﻤﺤﻣ
II
ﻪﻣﺪﻘﻣ
ﭙﻴﻟﻮﻠﻴﻣ ــ
ﻫرﻮﻣﻮﺗ زا مﻮ ــ
شﻮﺧ يﺎ
ﻴﺧ ــ ﺖـﺳا لﺎﻧردآ هﺪﻏ ﻢ
ﮕﻨﻫ رد ﺎـﻳ و ﻲﻗﺎـﻔﺗا ترﻮـﺻ ﻪـﺑ ًاﺮـﺜﻛا و هدﻮـﺑ ردﺎـﻧ ﻪﻛ ـــ
مﺎ
ﻲﻣ ﻒﺸﻛ ﻲﺴﭘﻮﺗا
دﻮﺷ .
ﻄﻜﻳ ًﻻﻮـﻤﻌﻣ رﻮـﻣﻮﺗ ﻦﻳا نوﺪـﺑ و ﻪـﻓﺮ
اﺰــﺟا ﻞﻣﺎــﺷ ﻲﭘﻮﻜــﺳوﺮﻜﻴﻣ ﻲــﺳرﺮﺑ رد و ﺖــﺳا ﺖــﻣﻼﻋ
ﻲﻣ ﻲﺑﺮﭼ و ﻚﻴﺘﻳﻮﭘﻮﺗﺎﻤﻫ
ﺪﺷﺎﺑ .
ﺖـﺳا مﻮﻠﻌﻣﺎـﻧ نآ ﺖﻠﻋ .
ﺮـﺜﻛا
ﻴﺨﺸﺗ ﺐﻠﻏا و هدﻮﺑ يدرﻮﻣ ترﻮﺻ ﻪﺑ تﺎﺷراﺰﮔ ــ
ﻴﻧ نآ ﺺ ـ
ﺰ
ﻲﻣ ﻲﻗﺎﻔﺗا
ﺪﺷﺎﺑ
، ﻲﺼـﻴﺨﺸﺗ يﺎﻬـﺷور دﺪـﻣ ﻪـﺑ هزوﺮـﻣا ﻲـﻟو
ﻪـــﻠﻤﺟ زا ﻪﺘﻓﺮﺸـــﻴﭘ
)CT
Computerized tomography (
و
)MRI
Magnetic resonance image (
، ﻦــﻳا ﺺﻴﺨﺸــﺗ ناﺰــﻴﻣ
ﺶﻴﺑ ﺎﻫرﻮﻣﻮﺗ
ﺖﺳا هﺪﺷ ﺮﺗ
).
1
ﻪﻟﺎﻘﻣ ﻦﻳا رد(
2 ﻪـﻛ رﺎـﻤﻴﺑ درﻮﻣ
ﻲﻤﺷﺎﻫ نﺎﺘﺳرﺎﻤﻴﺑ رد
ﻲـﺣاﺮﺟ ﻞـﻤﻋ ﺖـﺤﺗ داﮋﻧ ﻲﻣﻮﺘﻜﻟﺎـﻧردآ
ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﻣ ﻲﻓﺮﻌﻣ ،ﺪﻧا
ﺪﻧﻮﺷ .
رﺎﻤﻴﺑ ﻲﻓﺮﻌﻣ
ﻢﻧﺎﺧ ،رﺎﻤﻴﺑ ﻦﻴﻟوا 45
ﻪﻟﺎﺳ ﻢﻴﻣﺮﺗ ﺖﻬﺟ ﻪﻛ دﻮﺑ يا ﻖﺘﻓ
ﻓﺎﻧ ﻲ
ﺑ
مﺮﻛا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ﻪ )
ص ( ﻪﻛ دﻮﺑ هدﺮﻛ ﻪﻌﺟاﺮﻣ
ﻪـﻴﺣﺎﻧ رد ﻲﻛﻮﻜﺸـﻣ هدﻮـﺗ ،ﻲﻓاﺮﮔﻮﻧﻮﺳ لﺎﺒﻧد ﻪﺑ يو لﺎـﻧردآ
ﻳﺄﺗ زا ﺲـﭘ ﻪــﻛ ﺪــﺷ هﺪﻫﺎﺸـﻣ ﻂــﺳﻮﺗ ﺪــﻴ
CT scan ﻪــﺑ ،ﻢﻜــﺷ
ﻲﻤﺷﺎﻫ ﺪﻴﻬﺷ نﺎﺘﺳرﺎﻤﻴﺑ
ﺪﻳدﺮﮔ ﻞﻘﺘﻨﻣ داﮋﻧ .
رﺎﻤﻴﺑ ﻪﭽﺨﻳرﺎﺗ رد
ﻲـﻤﻧ ﺖـﻓﺎﻳ رﻮـﺑﺰﻣ هدﻮـﺗ ﺎـﺑ طﺎـﺒﺗرا رد ﻲـﺘﻣﻼﻋ ﭻﻴﻫ
ﺪـﺷ . رد
ﺎﻣزآ
هﺪﻣآ ﻞﻤﻌﺑ تﺎﺸﻳ
،
ﺗﻻﺎﺑ رﺎﻤﻴﺑ ﻦﻳﺮﻔﻧﺎﺘﻣ رﻮﻧ و ﻦﻳﺮﻔﻧﺎﺘﻣ ــ
ﺮ
ﻪﻘﺑﺎــﺳ ﭻﻴــﻫ ﻲــﻟو دﻮــﺑ هﺪــﺷ شراﺰــﮔ ﻲــﻌﻴﺒﻃ ﺪــﺣ زا زا يا
ﺖـﺷاﺪﻧ ﮓﻨﻴﺷﻮﻛ يرﺎﻤﻴﺑ ﺎﻳ و ﺎﻣﻮﺘﻴﺳﻮﻣوﺮﻛﻮﺌﻓ .
ﺖـﺤﺗ رﺎـﻤﻴﺑ
ﺎـﺑ هدﻮﺗ و ﺖﻓﺮﮔ راﺮﻗ ﺖﺳار ﺖﻤﺳ ﻲﻣﻮﺘﻜﻟﺎﻧردآ ﻲﺣاﺮﺟ ﻞﻤﻋ و ﻚﻳژارﻮﻤﻫ ،مﺮﻧ ،ﺺﺨﺸﻣ دوﺪﺣ يوﺎﺣ
دﺎﻌﺑا ﻪﺑ ﻲﺑﺮﭼ ﺖﻓﺎﺑ
8
× 6
× 5 ﻲﺘﻧﺎﺳ ﺪﻳدﺮﮔ جرﺎﺧ ﺮﺘﻣ )
هرﺎﻤﺷ ﻞﻜﺷ 1
.(
هﺪﻴﻜﭼ
ﻪﻣﺪﻘﻣ : شﻮﺧ يدﺮﻛرﺎﻛ ﺮﻴﻏ يﺎﻫرﻮﻣﻮﺗ زا مﻮﭙﻴﻟﻮﻠﻴﻣ مﺎﮕﻨﻫ رد و ﻲﻗﺎﻔﺗا ترﻮﺻ ﻪﺑ ًاﺮﺜﻛا ﻪﻛ ﺖﺳا لﺎﻧردآ هﺪﻏ ردﺎﻧ ًﺎﺘﺒﺴﻧ ﻢﻴﺧ
ﻲﻣ ﻒﺸﻛ ﻲﺴﭘﻮﺗا دﻮﺷ
. ﻲﻤﻧ دﺎﺠﻳا ﻲﻨﻴﻟﺎﺑ لﻼﺘﺧا و هدﻮﺑ ﻪﻓﺮﻄﻜﻳ و ﻚﭼﻮﻛ ﺐﻠﻏا ﻲﻧﻮﻣرﻮﻫ تﻻﻼﺘﺧا ،يدراﻮﻣ رد ﻲﻟو ﺪﻨﻨﻛ
شراﺰﮔ
ﺖﺳا هﺪﺷ .
ﻣ رﺎﻤﻴﺑ ﻲﻓﺮﻌ : ﻦﻳا رد ﻪﻟﺎﻘﻣ 2 ﺺﻴﺨﺸـﺗ ﺎـﺑ ود ﺮـﻫ ﻪـﻛ رﻮـﻣﻮﺗ ﻦـﻳا ﻪـﺑ ﻼﺘـﺒﻣ رﺎـﻤﻴﺑ درﻮـﻣ incidentaloma
نﺎﺘـﺳرﺎﻤﻴﺑ رد
ﻲﻤﺷﺎﻫ ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ داﮋﻧ ﻲﻣ ﻲﻓﺮﻌﻣ ،ﺪﻧا
ﺪﻧﻮﺷ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ :
ﭼ ﺖﻓﺎﺑ ،درﻮﻣ ود ﺮﻫ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ ﻲﺳرﺮﺑ رد ﺮ
ﺎﺴـﻧﻮﺧ يﺎﻬﻟﻮﻠـﺳ زا يﺮﻳاﺰﺟ هاﺮﻤﻫ ﻪﺑ هﺪﻴﺳر ﻲﺑ و هﺪﻫﺎﺸـﻣ ،ز
ﺪﻳدﺮﮔ شراﺰﮔ ﺎﻣﻮﭙﻴﻟﻮﻠﻴﻣ .
هژاوﺪﻴﻠﻛ ﺎﻫ : –1 مﻮﭙﻴﻟﻮﻠﻴﻣ –2 لﺎﻧردآ هﺪﻏ –3 يدﺮﻛرﺎﻛ ﺮﻴﻏ رﻮﻣﻮﺗ
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ 16 :
/ 10 / 83 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ ، 30 :
/ 1 / 85
(I ﺐﻴﺳآ ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا ﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺳﺎﻨﺷ
ﻲﻤﺷﺎﻫ ﺪﻴﻬﺷ ن ﻲﻟو نﺎﺑﺎﻴﺧ ،ﻚﻧو ناﺪﻴﻣ ،داﮋﻧ
،ناﺮﻬﺗ ،ناﺮﻳا ﻲﻧﺎﻣرد ـ ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺮﺼﻋ
ناﺮﻳا
*) لوﺆﺴﻣ ﻒﻟﺆﻣ .(
(II ﺐﻴﺳآ ﺺﺼﺨﺘﻣ ﻲﺳﺎﻨﺷ
.
ﻲﻓﺮﻌﻣ 2 لﺎﻧردآ مﻮﭙﻴﻟﻮﻠﻴﻣ درﻮﻣ
ﺮﺘﻛد يﺮﮕﺴﻋ نﺎﮔﮋﻣ و
ﻣ ﺮﺘﻛد ﻲﻗاﺮﻋ دﻮﻤﺤ
هرﺎﻤﺷ ﻞﻜﺷ 1
-
يﺰﻳﺮﻧﻮﺧ ﻲﺣاﻮﻧ ود رد مﺮﻛ ﻊﻄﻘﻣ ﺢﻄﺳ ﺎﺑ ﻞﻜﺷ ﻲﻀﻴﺑ هدﻮﺗ
يﺎﻗآ ،رﺎﻤﻴﺑ ﻦﻴﻣود 52
ﻪﻟﺎﺳ يﻮـﻠﻬﭘ درد ﺖﻠﻋ ﻪﺑ ﻪﻛ دﻮﺑ يا
ـﻣ ﻪﺑ ﺖﺳار
ـﻳ تﺪ هدﺮـﻛ ﻪـﻌﺟاﺮﻣ ،لﺎـﺳ ﻚ ـﺑ
دﻮ . ﻞـﻤﻋ ﻪﻘﺑﺎـﺳ
ﺎﻬﮕﻨـﺳ ياﺮـﺑ ﻪـﻧﺎﺜﻣ و ﺖﺳار ﻪﻴﻠﻛ ﻲﺣاﺮﺟ زا ار يراردا ي
20
ﻲﻣ ﺮﻛذ ﻞﺒﻗ لﺎﺳ
دﺮﻛ . رد
،ﺖـﺳار ﻪﻴﻠﻛ زوﺮﻔﻧورﺪﻴﻫ ،ﻢﻜﺷ CT
هدﻮﺗ ﻚﻳ ﺰﻴﻧ و ﺖﺳار ﻲﻧﺎﺘﺤﺗ ﺐﻟﺎﺣ ﮓﻨﺳ ،ﺖﺳار ﺮﺗرﻮﻳورﺪﻴﻫ
ﺪﺷ شراﺰﮔ ﺖﺳار ﺖﻤﺳ لﺎﻧردآ .
هﺪـﺷ مﺎـﺠﻧا تﺎﺸـﻳﺎﻣزآ رد
)VMA
Vanillylmandelic acid (
رﺎﻤﻴﺑ 5 / 1 لﺎـﻣﺮﻧ ﺪـﺣ ﺮـﺑاﺮﺑ
ﺪﺷ شراﺰﮔ .
ـﺨﺗ هدﻮـﺗ ﻚﻳ ﻲﺣاﺮﺟ ﻞﻤﻋ رد ﻢ
ﻪـﺑ ﻞﻜـﺷ ﻲـﻏﺮﻣ
دﺎﻌﺑا 5
× 5
× 7 ﻲﺘﻧﺎﺳ و ﻲـﺑﺮﭼ ﺖـﻓﺎﺑ يوﺎـﺣ ،ﮓﻧر ﻢﻛ ،مﺮﻧ ،ﺮﺘﻣ
ﺪﻳدﺮﮔ جرﺎﺧ لﺎﻧردآ ﻪﺑ ﻞﺼﺘﻣ )
هرﺎﻤﺷ ﻞﻜﺷ 2
و 3 .(
يﺎﻬﻟﻮﻠﺳ تﺎﺤﻔﺻ ،ﻪﻧﻮﻤﻧ ود ﺮﻫ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ ﻲﺳرﺮﺑ رد زﺎﺴـﻧﻮﺧ يﺎﻬﻟﻮﻠـﺳ هﺪـﻨﻛاﺮﭘ ﺮـﻳاﺰﺟ هاﺮﻤﻫ ﻪــﺑ ﻲﺑﺮﭼ هﺪﻴﺳر هدر ﻞﻣﺎﺷ
رﺎﻛﺎﮕﻣ و ﺪﻴﻳﻮﻠﻴﻣ ،ﺪﻴﻳوﺮﺘﻳرا يﺎﻫ هﺪﻫﺎﺸـﻣ ،ﺖﻴـﺳﻮﻳ
ﺪﻳدﺮﮔ حﺮﻄﻣ مﻮﭙﻴﻟﻮﻠﻴﻣ ﺺﻴﺨﺸﺗ و )
هرﺎﻤﺷ ﻞﻜﺷ 4
و 5 .(
هرﺎﻤﺷ ﻞﻜﺷ 2
- ﻢﺨﺗ هدﻮﺗ مﺮﻛ ﮓﻧر ﻪﺑ ﺺﺨﺸﻣ دوﺪﺣ ﺎﺑ ﻞﻜﺷ ﻲﻏﺮﻣ
هرﺎﻤﺷ ﻞﻜﺷ 3
- هﻮﻬﻗ ﻲﺣاﻮﻧ ﺎﺑ ﮓﻧر مﺮﻛ ﻊﻄﻘﻣ ﺢﻄﺳ يا
هرﺎﻤﺷ ﻞﻜﺷ 4
-
ﺮﻤﻫ ﻪﺑ ﻲﺑﺮﭼ يﺎﻬﻟﻮﻠﺳ تﺎﺤﻔﺻ ﻳاﺰﺟ ها
زﺎﺴﻧﻮﺧ يﺎﻬﻟﻮﻠﺳ ﺮ
هرﺎﻤﺷ ﻞﻜﺷ 5
- هدر يوﺎﺣ زﺎﺴﻧﻮﺧ يﺎﻬﻟﻮﻠﺳ عاﻮﻧا ﻣ يﺎﻫ
و ﺪﻴﻳﻮﻠﻴ
ﻳوﺮﺘﻳرا ﺰﻛﺮﻣ رد ﺖﻴﺳﻮﻳرﺎﻛﺎﮕﻣ ﻚﻳ و ﺪﻴ
ﺚﺤﺑ
شﻮــﺧ ﻪﻌﻳﺎــﺿ ﻚــﻳ لﺎــﻧردآ مﻮــﭙﻴﻟﻮﻠﻴﻣ و ردﺎــﻧ ،ﻢﻴــﺧ
ﻪـﺑ ﻪـﻛ ﺖـﺳا لﺎﻧردآ ﻪﻓﺮﻄﻜﻳ ًﻻﻮﻤﻌﻣ و يدﺮﻛرﺎﻛﺮﻴﻏ ـﺻ
ترﻮ
ﻲﻣ هداد ﺺﻴﺨﺸﺗ ﻲﻗﺎﻔﺗا
دﻮﺷ .
ناﻮﺟ داﺮﻓا رد رﻮﻣﻮﺗ ﻦﻳا
، ردﺎﻧ
ﺖﺳا
).
1
،هﺪـﺷ شراﺰـﮔ ﻲﻨﺳ ﻒﻴﻃ (
90 - 20
ﺖـﺳا لﺎـﺳ .
ﺐـﻠﻏا
ﻪـﻫد رد نارﺎﻤﻴﺑ 5
- 4 ﻲـﻣ ﺪﻨـﺷﺎﺑ
).
2
(
ﻪـﭽﺑ رد ﺰـﻴﻧ يدراﻮـﻣ
ﺎـﻫ
ﮔ ﺰ
ﺖﺳا هﺪﺷ شرا
).
3
ﻪـﻓﺮﻃ ود ترﻮـﺻ ﻪﺑ ﺖﺳا ﻦﻜﻤﻣ ترﺪﻨﺑ (
دﻮــﺷ هﺪــﻳد
).
4
،نآ ﻲﺴــﻨﺟ عﻮﻴــﺷ ،هﺪــﺷ مﺎــﺠﻧا تﺎــﻌﻟﺎﻄﻣ رد (
رد و نﺎﺴﻜﻳ ـﻳ
ﺮـﮕﻳد ﻪـﻌﻟﺎﻄﻣ ﻚ
، ،نز ﻪـﺑ دﺮـﻣ ﺖﺒﺴـﻧ 2
ﻪـﺑ 3
اﺰﮔ ﺖﺳا هﺪﺷ شر
).
5
(
ﺖﻨـﺳﻮﻟﻮﻳدار ﻪﻌﻳﺎـﺿ ترﻮﺻ ﻪﺑ مﻮﭙﻴﻟﻮﻠﻴﻣ ،ﻲﻓاﺮﮔﻮﻳدار رد
ﻲﻣ هﺪﻳد ﺺﺨﺸﻣ دوﺪﺣ ﺎﺑ
ًﻻﻮﻤﻌﻣ و دﻮﺷ ﻪﻴﻠﻛ ﻲﻳﺎﺠﺑﺎﺟ ﺚﻋﺎﺑ
ﻦﻴﻳﺎﭘ ﺖﻤﺳ ﻪﺑ ﻲﻣ
ﺎﺑ ﻪﻛ ددﺮﮔ
)IVP
Intravenous pyelogram (
ﻲﻣ ﺺﻴﺨﺸﺗ ﻞﺑﺎﻗ ﻲﺘﺣار ﻪﺑ
ﺪﺷﺎﺑ . ،ﻲﻓاﺮﮔﻮﻳﺮﺗرآ رد ﺑ
گر نوﺪ
ﻲــﻣ ﺲﻧدﻮــﻛا ،ﻲﻓاﺮﮔﻮﻧﻮــﺳ رد و ﺎﺑ
ﺪــﺷ . زا هدﺎﻔﺘــﺳا ﺎــﺑ و CT
MRI
ﻮﺘﺤﻣ ﺖﻠﻋ ﻪﺑ ا
هداد ﻲـﻌﻄﻗ ﺺﻴﺨﺸـﺗ ًﺎﺒﻳﺮﻘﺗ نآ ﻲﺑﺮﭼ ي
ﻲﻣ
)دﻮﺷ
1
ﻲﻳﺎـﻤﻨﻫار ﺎـﺑ ﻲﻧزﻮﺳ ﻲﺴﭘﻮﻴﺑ ﺖﺳا ﻦﻜﻤﻣ ﻲﻟو (
CT
ﺪﺷﺎﺑ مزﻻ ﻲﻓاﺮﮔﻮﻧﻮﺳ ﺎﻳ و ﻢﻜﺷ
).
6 و 7
(
طﺎـﺒﺗرا رد ﺖـﺳا ﻦـﻜﻤﻣ ﺎﻣا ﺖﺳا مﻮﻠﻌﻣﺎﻧ ،ﻪﻌﻳﺎﺿ ﻦﻳا ﺖﻠﻋ
ﭼ ﺖـﻓﺎﺑ هﺪـﻧﺮﻴﮔ ﺮـﺑ رد ﻪـﻛ ﺪـﺷﺎﺑ يدراﻮﻣ ﺎﺑ ﺮ
و ﻲـﺑ ﺪـﻴﻳﻮﻠﻴﻣ
ﺪﻨﺘﺴﻫ
).
1
ﻪـﺑ و ﺪﻨﺘﺴﻫ ﺖﻣﻼﻋ نوﺪﺑ ًﻻﻮﻤﻌﻣ ﻚﭼﻮﻛ يﺎﻫرﻮﻣﻮﺗ (
ﻲــﻣ ﻒﺸــﻛ ﻲﻗﺎــﻔﺗا ترﻮــﺻ ﺪﻧﻮــﺷ
. ،گرﺰــﺑ يﺎــﻫرﻮﻣﻮﺗ رد
ﻊﻳﺎﺷ
ﻲـﻣ ﺎﻫﻮﻠﻬﭘ و ﻢﻜﺷ ﻪﻴﺣﺎﻧ درد ،ﻪﻧﺎﺸﻧ ﻦﻳﺮﺗ
ﺪـﺷﺎﺑ . عﻮﻴـﺷ
ﻫ ،قﺎـــﭼ داﺮـــﻓا رد نآ ﻲﮔﺪـــﻧز و نﻮﻴﺴـــﻧﺎﺗﺮﭙﻴﻫ هاﺮـــﻤ
يﺎـــﻫ
ﺮﭘ ﺶﻴﺑ ،سﺮﺘﺳا ﺗ
ﺮ ﺖﺳا هﺪﺷ شراﺰﮔ
).
2
(
ﻢﻳﻼﻋ ﺮﻳﺎﺳ و ﺲـﻤﻟ ﻞـﺑﺎﻗ هدﻮـﺗ ،عﻮـﻬﺗ ،ﺖﺳﻮﺒﻳ زا ﺪﻨﺗرﺎﺒﻋ
يرﻮﭼﺎﻤﻫ .
ﻲﻧﻮـﻣرﻮﻫ ظﺎـﺤﻟ زا و ﻪﻴﻔﻴﺴـﻠﻛ ترﺪـﻨﺑ ،تﺎﻌﻳﺎﺿ
ﻲﻣ لﺎﻌﻓ ﺪﻨﺷﺎﺑ .
هزاﺪـﻧا ترﻮـﺻ ﺮﻫ رد
يﺮـﻴﮔ
ﻲﻧﻮـﻣرﻮﻫ يﺎـﻫ
،
ﺖــﺳا مزﻻ
، مﻮــﭙﻴﻟﻮﻠﻴﻣ ﺎــﺑ لﺎــﻜﻴﺗرﻮﻛ مﻮــﻧدآ ﻲﻧﺎــﻣﺰﻤﻫ اﺮــﻳز
ﺖـﺳا هﺪـﺷ شراﺰﮔ .
ترﻮـﺻ ﻪـﺑ رﻮـﻣﻮﺗ ﺖـﺳا ﻦـﻜﻤﻣ ًﺎﺗرﺪـﻧ
د ﺎـﻳ و ﻲﻧﺎﻬﮔﺎﻧ ر
ﺮـﺛا ﻊﻴـﺳو يﺰﻳﺮﻧﻮـﺧ و هﺪـﺷ هرﺎـﭘ ،ﺎـﻣوﺮﺗ
ﭘوﺮﺗر ﺋﻮﺘﻳﺮ دﻮﺷ ﺐﺒﺳ ار ﻦ
).
8 و 9
(
ﺖﺳا توﺎﻔﺘﻣ رﺎﻴﺴﺑ رﻮﻣﻮﺗ هزاﺪﻧا .
زا ﺮـﺘﻤﻛ ًﻻﻮﻤﻌﻣ نآ ﺮﻄﻗ
5 ﻲﺘﻧﺎﺳ ﺮـﻄﻗ ﻪـﺑ يﺎﻫرﻮﻣﻮﺗ ﻲﻟو ،ﺖﺳا ﺮﺘﻣ 34
ﻲﺘﻧﺎـﺳ و ﺮـﺘﻣ
زا ﺶﻴﺑ نزو 5
هﺪـﺷ شراﺰـﮔ ﺰﻴﻧ مﺮﮔﻮﻠﻴﻛ
ﺪـﻧا . Damjanov و
ﺮــﻄﻗ ﻪــﺑ ار ﻲﻣﻮــﭙﻴﻟﻮﻠﻴﻣ ،ﺶﻧارﺎــﻜﻤﻫ 15
ﻲﺘﻧﺎــﺳ شراﺰــﮔ ﺮــﺘﻣ هدﺮﻛ
دﻮـﺑ ﻪـﺘﻓﺮﮔ راﺮـﻗ لﺎـﻧردآ زا جرﺎﺧ ﻪﻛ ﺪﻧا .
رﻮـﻣﻮﺗ ﺮﻫﺎـﻇ
ﺪـﺷﺎﺑ دﺎـﻳز نآ ﺪـﻴﻳﻮﻠﻴﻣ ﺖﻤﺴـﻗ ﺮـﮔا ﻲﻟو دراد ار مﻮﭙﻴﻟ يﺎﻤﻧ ﻲﻣ رﻮﻣﻮﺗ
هاﺮـﻤﻫ ﻪـﺑ ﺰﻣﺮﻗ يﺮﺘﺴﻛﺎﺧ ﺎﻳ يﺮﺘﺴﻛﺎﺧ ﮓﻧر ﺪﻧاﻮﺗ
ﻪﻜﻟ هﻮﻬﻗ يﺎﻫ
ﺪﺷﺎﺑ ﻪﺘﺷاد يا
).
10 و 11
لﻮﺴﭙﻛ نوﺪﺑ ًاﺮﺜﻛا رﻮﻣﻮﺗ (
ﺢﺿاو ﻲﻣ ﻤﻌﻣ ﻲﻟو ﺪﺷﺎﺑ دراد ﺺﺨﺸﻣ دوﺪﺣ ًﻻﻮ
).
4
(
ﻓﺎﺑ زا ﻪﻌﻳﺎﺿ ،ﻚﻴﭘﻮﻜﺳوﺮﻜﻴﻣ يﺎﻤﻧ رد ﺖ
ﻪـﺑ ﻲﺑﺮﭼ هﺪﻴﺳر
هﺪــﻨﻛاﺮﭘ ﺮــﻳاﺰﺟ هاﺮــﻤﻫ ﻞﻴﻜﺸــﺗ ﻚــﻴﺘﻳﻮﭘﻮﺗﺎﻤﻫ يﺎﻬﻟﻮﻠــﺳ زا يا
ﺖـﺳا هﺪﺷ .
نﻮﻧﺎـﻛ ﺖـﺳا ﻦـﻜﻤﻣ
ﻞﻴﻜﺸـﺗ ،يﺰﻳﺮﻧﻮـﺧ زا ﻲﻳﺎـﻫ
يﺎـﻫرﻮﻣﻮﺗ رد ناﻮﺨﺘـﺳا يزﻼﭘﺎـﺘﻣ و نﻮﻴﺳﺎﻜﻴﻔﻴﺴﻠﻛ ،ﺖﺴﻴﻛ دﻮــﺷ هﺪﻫﺎﺸــﻣ گرﺰــﺑ .
نﺎــﻜﻣا ﻦﻴــﻨﭽﻤﻫ نﻮﻧﺎــﻛ دراد
زا ﻲﻳﺎــﻫ
ﻞــﻴﺒﻗ زا لﺎــﻧردآ ﺮــﮕﻳد تﺎﻌﻳﺎــﺿ رد زﻮﺗﺎــﻣﻮﭙﻴﻟﻮﻠﻴﻣ تاﺮــﻴﻴﻐﺗ لﺎـﻣﺮﻧ لﺎـﻧردآ ﺰـﻴﻧ و ﺲﻜﺗرﻮـﻛ يزﻼﭘﺮﭙﻴﻫ ،لﺎﻜﻴﺗرﻮﻛ مﻮﻧدآ ددﺮﮔ هﺪﻫﺎﺸﻣ
).
5
ﺺﺨﺸـﻣ تﺎﻌﻳﺎـﺿ ﻦـﻳا ﺰﻧژﻮﺘﺴـﻴﻫ ﺖـﻴﻫﺎﻣ (
ﺖﺴﻴﻧ .
ﻲـﻣ ﺖـﻣﻼﻋ نوﺪـﺑ ﺐﻠﻏا مﻮﭙﻴﻟﻮﻠﻴﻣ ﻪﭼ ﺮﮔا
ﻲـﻟو ﺪـﺷﺎﺑ
ﺖﻣﻼﻋ دراﻮﻣ
ﺖـﺳا هﺪـﺷ شراﺰـﮔ ﻢـﻫ نآ راد
).
2
ﻪـﺑ ﻦﻴـﻨﭽﻤﻫ (
لﺎـﻌﻓ ﻲﻧﻮﻣرﻮﻫ ظﺎﺤﻟ زا ﻪﻛ لﺎﻧردآ تﺎﻌﻳﺎﺿ زا ﻲﻀﻌﺑ هاﺮﻤﻫ لﺎــــﻜﻴﺗرﻮﻛ مﻮــــﻧدآ ﻞــــﻴﺒﻗ زا ﺪﻨﺘﺴــــﻫ
) 14 - 12
مﻮﻨﻴــــﺳرﺎﻛ ،(
لﺎــﻜﻴﺗرﻮﻛﻮﻧردآ
) 9
ﺎﻣﻮﺘﻴــﺳﻮﻣوﺮﻛﻮﺌﻓ ،( )
15
،ﮓﻨﻴــﺷﻮﻛ مرﺪﻨــﺳ ،(
لﺎﻧردآ يزﻼﭘﺮﭙﻴﻫ
) 16
دﻮﺒﻤﻛ ،(
21
زﻼﻴﺴـﻛورﺪﻴﻫ
) 17
مرﺪﻨـﺳ و (
Conn’s
) 18
(
ﺖﺳا هﺪﺷ شراﺰﮔ ، .
ﻮﮔ ﻦﻳا رد ﺮـﺑ ضﺮـﻓ دراﻮﻣ ﻪﻧ
يﺎﻣوﺮﺘـﺳا يﺎﻬﻟﻮﻠـﺳ يزﻼﭘﺎـﺘﻣ زا تﺎﻌﻳﺎﺿ ﻦﻳا ﻪﻛ ﺖﺳا ﻦﻳا لﺎﻧردآ
نﻮﻣرﻮﻫ ﺮﺛا ﺖﺤﺗ
ﻲﻣ دﺎﺠﻳا ،ﺎﻫ
ﻮﺷ ﺪﻧ .
ﻲـﻣ ﺮﻈﻧ ﻪﺑ
ﺪـﺳر
يﺎﻬﻟﻮﻠﺳ يﺎﻳﺎﻘﺑ ،ﻪﻌﻳﺎﺿ ﺄﺸﻨﻣ ،لﺎﻧردآ جرﺎﺧ دراﻮﻣ رد Stem
ﻲﻣ ﻲﻣﻮﺘﺴﻳرﻮﻛ ﻚﻴﺘﻳﻮﭘﻮﺗﺎﻤﻫ ﺪﺷﺎﺑ
).
19 و 20
(
ﺗﺎﻤﻫ يﺎــﻫرﻮﻣﻮﺗ ،ﻢــﻬﻣ ﻲــﻗاﺮﺘﻓا ﺺﻴﺨﺸــﺗ ﺎــﻬﻨﺗ ﻚــﻴﺘﻳﻮﭘﻮ
ﻲﻣ ﺮﻟوﺪﻣاﺮﺘﺴﻛا هاﺮـﻤﻫ ًﻻﻮـﻤﻌﻣ و هدﻮـﺑ دﺪﻌﺘﻣ ًاﺮﺜﻛا ﻪﻛ ﺪﻨﺷﺎﺑ
ﻲﻣ ﻲﻟﺎﮕﻣﻮﺗﺎﭙﻫ و ﻲﻟﺎﮕﻣﻮﮕﻨﻠﭙﺳا
ﺪﻨﺷﺎﺑ . ﻪـﺑ ﻪﻳﻮﻧﺎﺛ ﺎﻫرﻮﻣﻮﺗ ﻦﻳا
يرﺎـﻤﻴﺑ ،ﺪﻳﺪـﺷ ﻲﻤﻧآ
و زوﺮﻠﻜـﺳاﻮﻠﻴﻣ ،ﻮـﻴﺗاﺮﻔﻴﻟوﺮﭘﻮﻠﻴﻣ يﺎـﻫ
ﻲﻣ دﺎﺠﻳا ﻲﺘﻠﻜﺳا تﻻﻼﺘﺧا
ﺪﻧﻮﺷ
).
19 و 20
ﻢـﻬﻣ ﻲﺼـﻴﺨﺸﺗ ﻪﺟو (
ﻮﺑ ﺐﻟﺎﻏ ،مﻮﭙﻴﻟﻮﻠﻴﻣ ﻊﻔﻧ ﻪﺑ يزﻼﭘﺮـﭙﻴﻫ مﺪـﻋ و ﻲـﺑﺮﭼ ءﺰﺟ ند
ﻲﻣ ﺪﻴﻳوﺮﺘﻳرا ﺪﺷﺎﺑ
).
5
(
شﻮﺧ ًﻼﻣﺎﻛ مﻮﭙﻴﻟﻮﻠﻴﻣ
ﺺﻴﺨﺸـﺗ ترﻮـﺻ رد و هدﻮـﺑ ﻢﻴـﺧ
شور ﻪــﺑ ﻖــﻴﻗد وCT
ﻲــﺣاﺮﺟ ﻞــﻤﻋ ﻪــﺑ ﻲﺟﺎــﻴﺘﺣا ،MRI
ﻲﻤﻧ ﺪﺷﺎﺑ
).
1
سﻮﺗﺎـﻣﻮﭙﻴﻟﻮﻠﻴﻣ تاﺮـﻴﻴﻐﺗ زا ﻲﻘﻃﺎـﻨﻣ ﺖﺳا ﻦﻜﻤﻣ (
ﻲﻓﺮﻌﻣ 2 لﺎﻧردآ مﻮﭙﻴﻟﻮﻠﻴﻣ درﻮﻣ
ﺮﺘﻛد يﺮﮕﺴﻋ نﺎﮔﮋﻣ و
ﻣ ﺮﺘﻛد ﻲﻗاﺮﻋ دﻮﻤﺤ
هﺪﻫﺎﺸـﻣ لﺎﻧردآ يزﻼﭘﺮﭙﻴﻫ دراﻮﻣ و لﺎﻜﻴﺗرﻮﻛ يﺎﻫرﻮﻣﻮﺗ رد ﻛ ﺪﻧﻮﺷ
ﺶﻴـﭘ ترﻮﺻ نآ رد ﻪ
ﻪـﻃﻮﺑﺮﻣ ﻪﻌﻳﺎـﺿ ،ار نآ ﻲـﻬﮔآ
ﻲﻣ ﻦﻴﻴﻌﺗ ﺪﻨﻛ
).
5
(
زا ﺮﺘﻤﻛ 40
% شراﺰـﮔ لﺎـﻧردآ جرﺎـﺧ رد ،مﻮـﭙﻴﻟﻮﻠﻴﻣ دراﻮﻣ
ﺖــﺳا هﺪــﺷ .
زا ﺪــﻨﺗرﺎﺒﻋ هﺪــﺷ شراﺰــﮔ ﻲﺣاﻮــﻧ :
ﺮــﺘﻧاﺰﻣ
) 21
،(
)لﺎﺤﻃ
22
ﻪﻀﻴﺑ ،( ) 23
ﻦﺘﺳﺎﻳﺪﻣ ،( )
24 و 25
(
ﻪـﻴﻠﻛ سﻮﻨﻴـﺳ و
).
26
ﻦـﻳا (
ﻢﻧﺎﺧ رد ﺐﻠﻏا دراﻮﻣ
ﻲـﻣ هﺪـﻳد ﻎﻟﺎـﺑ يﺎـﻫ فﻼـﺧ ﺮـﺑ و ﺪﻧﻮـﺷ
ﻲﺘﻟﻮـﻣ ترﺪﻨﺑ ﻚﻴﺘﻳﻮﭘﻮﺗﺎﻤﻫ ﺮﻟوﺪﻣاﺮﺘﺴﻛا يﺎﻫرﻮﻣﻮﺗ
ﻚﻳﺮﺘﻨـﺳ
ﻲﻣ ﺪﻨﺷﺎﺑ
).
5
(
گرﺰﺑ يﺎﻫرﻮﻣﻮﺗ رد
زا ﺮﺗ 4 ﻲﺘﻧﺎﺳ ﺪﺷر ﺎﺑ يﺎﻫرﻮﻣﻮﺗ ،ﺮﺘﻣ
مﺎــﺠﻧا ﻲــﺣاﺮﺟ نﺎــﻣرد ،ﻲﻨﻴﻟﺎــﺑ لﻼﺘــﺧا ﺎــﺑ دراﻮــﻣ و ﻊﻳﺮــﺳ ﻲﻣ دﻮﺷ .
ﻚـﭼﻮﻛ رﻮﻣﻮﺗ ﻪﻛ يدراﻮﻣ رد
ﻲﺘﻓﺮﺸـﻴﭘ و ﺖـﺳا ﺮـﺗ
ﻲﻤﻧ نﺎﺸﻧ
ﺑ هﺪﻫﺎﺸﻣ ،ﺪﻫد ﻪﻴﺻﻮﺗ يژﻮﻟﻮﻳدار ﺎﺑ يﺮﻴﮕﻴﭘ و رﺎﻤﻴ
ﻲﻣ دﻮﺷ
).
1 (
ﺖــﻓﺎﻳ ﻲﻗﺎــﻔﺗا ترﻮــﺻ ﻪــﺑ ﺎــﻫرﻮﻣﻮﺗ ﻦــﻳا ﺮــﺜﻛا ﻪــﻛ ﺎــﺠﻧآ زا
ﻲــﻣ ﻚــﻳژﻮﻟﻮﻳدار يﺎﻬــﺷور ﺎــﺑ ﺎــﻬﻧآ ﺺﻴﺨﺸــﺗ ﺰــﻴﻧ و ﺪﻧﻮــﺷ
ﻲﻣ رﺎﻈﺘﻧا ،ﺖﺳا ﺮﻳﺬﭙﻧﺎﻜﻣا
ﺎـﻫرﻮﻣﻮﺗ ﻦـﻳا ﻲﺣاﺮﺟ دور
، ﺶﻫﺎـﻛ
ﺺﻴﺨﺸـﺗ ﺎـﺑ نارﺎـﻤﻴﺑ و ﻪﺘﻓﺎﻳ
ﻞـﻴﺒﻗ زا ﻲﻳﺎـﻫ incidentaloma
،
ﻞﻤﻋ ﺖﺤﺗ ﺪﻧﺮﻴﮕﻧ راﺮﻗ
.
ﻊﺑﺎﻨﻣ ﺖﺳﺮﻬﻓ
1- Walsh PC, Retick AB, Vaughen ED, Wein AJ.
Compbell’s Urology. 8th ed. Philadelphia: WB Saunders company; 2001. p. 3525-6.
2- Bednarek-Tupikowska G, Tupikowski K, Akinpelumi BF. Adrenal myelolipoma. Pol Merkur Lekarshi 2005 Jan;
18(103): 107-10.
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ﻲﻓﺮﻌﻣ 2 لﺎﻧردآ مﻮﭙﻴﻟﻮﻠﻴﻣ درﻮﻣ
ﺮﺘﻛد يﺮﮕﺴﻋ نﺎﮔﮋﻣ و
ﻣ ﺮﺘﻛد ﻲﻗاﺮﻋ دﻮﻤﺤ
Adrenal Myelolipoma: A Report of Two Cases
I II
*M. Asgari, MD M. Araghi, MD
Abstract
Introduction: Myelolipoma is one of the rare benign nonfunctioning tumors of adrenal gland that is often diagnosed incidentally or during autopsy. This tumor is usually small, unilateral and causes no clinical disorders but there have been some cases coexisting with endocrine disorders.
Case Report: The present study reports two patients who underwent adrenalectomy with the clinical impression of incidentaloma in Hashemi-Nejad Hospital.
Conclusion: Microscopic evaluation of both specimens revealed mature fat tissue admixed with islands of hematopoietic cells, which was diagnosed as myelolipoma.
Key Words: 1) Myelolipoma 2) Adrenal Gland 3) Nonfunctioning Tumor
I) Assistant Professor of Pathology. Shahid Hashemi-Nejad Hospital. Iran University of Medical Sciences and Health Services. Tehran, Iran.(*Corresponding Author)
II) Pathologist.
