张南，陈英敏

患者女，56岁，因“体检发现左侧肾上腺占位1个月余”入河北省人民医院，无明显临床症状。查体：一般状况良好。

影像表现：超声示左肾后方可探及一低回声团，大小约4.4 cm×4.0 cm×3.4 cm，边界欠清，内回声欠均。彩色多普勒及能量图：左肾后方低回声团未见明显血流信号。MRI示T1WI(图1A)呈高低混杂信号，病变于T1WI反相位较同相位信号未见明显变化(图1B)，T2WI呈混杂稍高信号(图1C)，扩散加权成像(dif f usion weighted imaging，DWI)呈不均匀高信号(图1D)，增强扫描病灶内部强化不明显，包膜可见轻度延迟强化(图1E)。CT示左侧腹膜后区可见团块状稍低密度影(图1F)，大小约4.2 cm×3.9 cm×4.0 cm，密度欠均匀，病变内可见散在小点片状脂肪密度影，形态欠规则，局部可见两处类圆形脂肪密度影突起，边缘可见斑点状钙化，病变与左侧肾上腺外侧肢分界欠清，增强扫描未见明显强化(图1G)。

图1 女，56岁，肾上腺表皮样囊肿。A：箭所示为病变部位，MRI平扫T1WI呈高低混杂信号；B：箭所示为病变部位，MRI平扫T1WI反相位较同相位信号未见明显变化；C：箭所示为病变部位，MRI平扫T2WI呈混杂稍高信号；D：箭所示为病变部位，DWI呈不均匀高信号；E：箭所示为病变部位，增强扫描病变内部强化不明显，包膜可见轻度延迟强化；F：箭所示为病变部位，CT平扫呈稍低密度影；G：箭所示为病变部位，CT增强扫描未见明显强化；H：病理图(HE×200)Fig.1 Female,56 years old,epidermoid cyst of the adrenal gland.A:The arrow showsthe lesion,with the mixed signal of high and low on T1 weighted image;B:The arrow shows the lesion,the lesion signal has no obvious change on both in-phase and out-phase sequence;C:The arrow shows the lesion,with the mixed slightly high-signal intensity on T2 weighted image;D:The arrow shows the lesion,DWI shows high signal,and signal is inhomogeneity;E:The arrow shows the lesion,contrast-enhanced scan shows no obvious internal enhancement and slightly delayed enhancement in the capsule;F:The arrow shows the lesion,plain CT scan shows a slightly lower density;G:The arrow shows the lesion,contrast-enhanced CT scan shows no significant enhancement;H:The pathological pictures(HE×200).

影像诊断：考虑来源于左侧肾上腺可能性大，髓样脂肪瘤可能性大。

在腹腔镜下行左侧肾上腺肿瘤切除术，术中见肿物来源于左侧肾上腺，与腔静脉及左肾静脉粘连严重，难以分离，遂切除部分肿瘤。……