A case of mistaken identity: Giant cystic pheochromocytoma

Antedomenico, Elena; Wascher, Robert A.

doi:10.1016/j.cursur.2004.08.015

Cited by 30 publications

(31 citation statements)

References 11 publications

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“…Therefore, blocking the effects of released catecholamines are recommended for all patients with biochemically positive PCCs (14). However, in the case of silent PCCs which are not diagnosed until the tumor is further investigated, surgeons may prefer to complete the resection immediately following achieving control over the hypertension during surgery (3,7,10,15,16) compared with postponing the surgery until later (17), despite the evidence that this may result in a hypertensive crisis (3,7), ventricular ectopic rhythms and cardiac arrest (10), or acute myocardial damage as in the present report. When unexpected hypertension occurs during resection of an abdominal tumor, the anesthesiologist and surgeon must consider the diagnosis of pheochromocytoma and clearly realize that it is an anesthetic challenge.…”

Section: Discussionmentioning

confidence: 99%

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Undiagnosed giant cystic pheochromocytoma: A case report

Wang

Sun

et al. 2015

Oncology Letters

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Abstract. Giant cystic pheochromocytomas (GPCCs) are rare adrenal tumors and the majority of them present as asymptomatic. As a result GPCCs often remain undiagnosed until surgery and therefore the surgical team face a greater challenge in perioperative management. The present study describes the case of a 36 year-old woman with an undiagnosed GPCC, which was successfully resected despite the occurrence of perioperative cardiovascular events, including hypertension, hypotension, ventricular arrhythmias, acute heart failure, acute myocardial infarction, and the patient was discharged home without any recurrence. It should be considered in retroperitoneal tumour of patients with nonspecific symptoms and given adequate treatment to promote the perioperative safety. IntroductionPheochromocytoma (PCC), a rare catecholamine-producing tumor with an estimated incidence of 0.005-0.1% in the worldwide population (1), may result in classical symptoms, including severe hypertension accompanied by headache and palpitation requiring proactive preoperative medical management to decrease morbidity and mortality. However, there are certain exceptions that have been described traditionally as the ̔10% rule̓, as they occur at an incidence of ~10% within patients with PCC (1,2). ̔Silent̓ PCC is one of the exceptions that does not exhibit classic PCC symptoms (3); therefore, ̔silent̓ PCC often remains undiagnosed until surgical excision occurs and the anesthesia teams face a greater challenge. The authors report the case of a silent giant cystic pheochromocytoma (GPCC), which was preoperatively diagnosed as a malignant renal mass; GPCC was confirmed as a result of the classical hypertension crisis following surgical exploration and histopathological evaluation. Case reportWritten informed consent was obtained from the patient and the institutional ethics review board was consulted for approval (not deemed necessary by the Institutional Ethics Review Board of Qilu Hospital, Jinan, China) for publishing this case.A 36-year-old woman presented to Qilu Hospital of Shandong University on May 9, 2013, with the primary complaint of abdominal discomfort following eating and lumbodorsal distending pain for 3 months, and reported weight loss of 8 kg during this time. The patient's medical history included a caesarean section and an ovarian cysts surgery, but no history of hypertension or headache. The patient's vital signs included an arterial blood pressure of 120/80 mmHg, heart rate of 80 bpm and temperature 36.8˚C. The only significant finding during physical examination was for left renal region percussion pain. Laboratory analysis identified a slightly elevated blood glucose level of 7.73 mmol/l (normal range, 3.90-6.10 mmol/l). Ultrasonography examination revealed a cystic space-occupying lesion (10.3x9.3 cm) in the left upper abdomen, which was considered to be a left renal cystic mass. Abdominal computed tomography (CT) and a contrast-enhanced CT scan demonstrated a giant cystic-solid mass on the left kidney, which occupied a large pa...

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Section: Discussionmentioning

confidence: 99%

“…Large adrenal tumors may also cause atrophy of the gland, making the residual gland unrecognizable. Therefore, they are often not accurately diagnosed until the time of resection, when hemodynamic instability occurs, or even following evaluation of pathological specimens (7,(9)(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed giant cystic pheochromocytoma: A case report

Wang

Sun

et al. 2015

Oncology Letters

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“…4,7,8 Seventy-five percent of affected patients suffer from sudden and unexpected weekly attacks, while others just once every few months. 3 Hypertension is the most common sign, reported in 48% to 70% of cases, while dyspnea is only reported in 11% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Essential intra-operative surgical steps include early isolation of the tumour's venous drainage with minimal manipulation of the mass followed by complete resection of the tumour. 4 Preoperative management is essential to prevent hemodynamic instability and hypertensive crisis before or during surgery, which usually includes α-adrenergic blockade with phenoxybenzamine first and then ß-blockade, with sufficient hydration with intravenous fluids the night before surgery. 1,5,9 Postoperatively, patients typically experience BP fluctuations, heart rate fluctuations and hypoglycemia, warranting intensive care monitoring for at least 24 hours after the operation.…”

Section: Discussionmentioning

confidence: 99%

“…3 PCCs are bilateral, malignant, pediatric, or asymptomatic in 10% of cases. 4 Hereditary PCC is associated with von Hippel-Lindau (VHL) syndrome, multiple endocrine neoplasia type 2 (MEN-2A/2B), neurofibromatosis type 1 (NF1), and hereditary pheochromocytoma-paraganglioma (due to mitochondrial succinate dehydrogenase gene mutations). 1,5 PCC classically presents with the quartet of episodic headaches, palpitations, diaphoresis, and hypertension.…”

Section: Introductionmentioning

confidence: 99%

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Largest pheochromocytoma reported in Canada: A case study and literature review

Ambati

Jana

Domes

2014

CUAJ

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Most giant pheochromocytomas do not present with classic symptoms, as documented by published case reports. Given this, clinicians have to consider a wide differential diagnosis for any retroperitoneal mass and perform screening tests to rule out a pheochromocytoma. We describe the largest pheochromocytoma reported in Canada, where the patient presented with a palpable abdominal mass and dyspnea. The 19 × 18 × 12-cm right retroperitoneal mass was biochemically active and was radiologically and pathologically consistent with a giant pheochromocytoma. We present this case and review the relevant current literature.

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