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

Abstract

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.

Giant multicystic malignant pheochromocytoma

“…The average tumor size is approximately 7 cm, and the average weight is approximately 200 g in the previous publications (2). Sometimes these tumors may be bigger (1,(3)(4)(5)(6)(7)(8). In this report, a case of multicystic malignant pheochromocytoma with a huge size is presented, which is seldom reported in the past.…”

“…The average tumor size is approximately 7 cm (2). There are only few reports of huge multicystic malignant pheochromocytoma above 18 cm, and to our knowledge, the pheochromocytoma in this case is the largest one reported from our country (1,(3)(4)(5)(6)(7)(8). Seven giant pheochromocytomas larger than 16 cm in current literature have been documented (Table 1).…”

“…Most pheochromocytomas are benign and approximately 10% have malignant behavior (1). With increasing size, the probability of malignancy becomes higher; in lesions over 6 cm, the ratio of benign-to-malignant tumors is 1:8 (9).…”

“…Pheochromocytoma is a rare tumor originating from the embryonic neural crest and secreting high levels of catecholamines (1). Though it may remain silent, it usually causes clinical symptoms such as headache, palpitation, and hypertension due to these secretions.…”

Giant Cystic Pheochromocytoma with Low Risk of Malignancy: A Case Report and Literature Review

“…Consequently, the time to diagnosis is delayed and tumor size tends to be larger once it is detected. A recent report that reviewed 20 cases of PCCs larger than 10 cm reported that 13 presented with abdominal pain with only 5 presenting with any of the classical symptoms of PCCs [16]. …”