Malignant Pheochromocytoma Lacking Clinical Features of Catecholamine Excess Until the Late Stage.

Honda, Munehiro; Uesugi, Kazuto; Yamazaki, Hiroyuki; Dezawa, Akira; Mizuguchi, Kunio; Yamaji, Taketo; Ishibashi, Masayoshi

doi:10.2169/internalmedicine.39.820

Cited by 7 publications

(10 citation statements)

References 19 publications

(21 reference statements)

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“…Se han descrito casos de aparición de metástasis óseas tras 12 años (17) de tratamiento del tumor primario, como es el caso de nuestro enfermo, en el cual aparecieron metástasis óseas 14 años después del diagnóstico del tumor primario. Por ello sería aconsejable considerar cada caso de feocromocitoma como potencialmente maligno y realizar un seguimiento prolongado tras el tratamiento del tumor primario para detectar la existencia de metástasis (17).…”

Section: Discussionunclassified

Feocromocitoma maligno tratado con MIBG I131: una larga supervivencia

Martínez

Hernandez

Couto

et al. 2003

An. Med. Interna (Madrid)

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El feocromocitoma maligno supone el 10-20% de los feocromocitomas (1). Es una neoplasia de mal pronóstico, ya que su supervivencia a los cinco años es del 40% (2). No existen criterios histológicos o bioquímicos para determinar la malignidad de este tumor, y es diagnosticado sólo por demostración de tejido tumoral en localizaciones donde, en condiciones normales, no existen células cromafines, principalmente en huesos, hígado, pulmón y ganglios linfáticos (1,3). El principio básico del tratamiento, siempre que sea posible, es la cirugía, tanto del tumor primario como de las metástasis, así como de las posibles recidivas. Los fármacos antihipertensivos se usan para bloquear los efectos de las catecolaminas mientras que la alfametiltirosina inhibe la síntesis de catecolaminas, pero éstas terapias no inhiben el crecimiento de los tumores. El empleo de radioterapia, que sólo resulta útil a dosis superiores a 40 Gy tiene poco valor en tejidos blandos y es más eficaz en metástasis óseas para el control del dolor o si masas de tumor irresecable producen síntomas locales (4). La quimioterapia, con una combinación de ciclofosfamida, vincristina y dacarbacina, tan sólo tiene una finalidad paliativa, habiéndose descrito unos resultados variables (4,5). Otra alternativa al tratamiento de estos tumores es la utilización de metiliodobencilguanidina marcada con I 131 (I 131 MIBG), radioisótopo que se utiliza desde mediados de los años 80 para el diagnóstico de este tipo de neoplasias (6).

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Section: Discussionunclassified

Feocromocitoma maligno tratado con MIBG I131: una larga supervivencia

Martínez

Hernandez

Couto

et al. 2003

An. Med. Interna (Madrid)

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“…Surgery to resect tumors can cause unexpected oversecretion of catecholamines and severely raise systolic blood pressure [2,5,6] , and it is important to try to avoid such hypertension. In our institution, the drainage vein (i.e., the adrenal vein) is ligated as soon as possible during surgery, followed by ligation of the adrenal artery.…”

Section: Case Reportmentioning

confidence: 99%

“…Current therapies for pheochromocytoma and close longterm follow-up can result in good survival rates [6][7][8] , even although patients with recurrence eventually die due to hypertensive crisis. The liver is the most common site of pheochromocytoma metastasis.…”

Section: Case Reportmentioning

confidence: 99%

Malignant pheochromocytoma: Hepatectomy for liver metastases

Hori

Yamagiwa

Hayashi

et al. 2013

WJGS

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Malignant pheochromocytoma accounts for approximately 10% of pheochromocytoma cases. The main site of distant metastasis is the liver. Hypertensive crisis due to catecholamine oversecretion is potentially fatal. We present a case of malignant pheochromocytoma with multiple liver metastases. A 60-year-old female with repeated hypertensive episodes was diagnosed with malignant pheochromocytoma. She underwent a left adrenalectomy and partial hepatectomy with resection of segment 6. Catecholamine levels remained high after surgery and she received repeated cycles of chemotherapy. Four months after surgery, multiple liver metastases were detected. In spite of ongoing chemotherapy, catecholamine levels eventually became uncontrollable. Serum and urine noradrenaline and vanillylmandelic acid levels increased, but adrenaline and dopamine levels stayed within the normal range. Preoperative liver imaging revealed multiple metastases in all segments except segment 4. Percutaneous transhepatic portal vein embolization (PTPE) of the right and lateral branches of the portal vein was performed. The functional liver volume of segment 4 increased after PTPE. Right hepatectomy, lateral segmentectomy and partial resection of segment 1 were performed 10 mo after the initial surgery. Intraoperative ultrasonography detected two small tumors in segment 4, which were treated with intraoperative microwave coagulation therapy. Noradrenaline levels normalized immediately after the second hepatectomy. As there was increased telomerase activity in the resected specimen, she received adjuvant chemotherapy. She remained in good health for 2 years. However, further metastases eventually occurred and she subsequently died due to a brain hemorrhage. Hepatectomy may be a therapeutic option for reduction of tumor mass in pheochromocytoma with liver metastases.

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“…As the histological criteria are not enough to confirm the benign nature of a pheochromocytoma, all patients should be carefully followed up after surgical resection to detect any recurrence or metastasis. 7,8 In other words all cases of pheochromocytomas should be treated as potentially malignant.…”

Section: Case Reportmentioning

confidence: 99%

Clavicular metastasis, an initial manifestation of a malignant pheochromocytoma - a case report

Karabi

Ghosh

et al. 2007

J Cytol

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We present a 55 years old lady having an unusual presentation of abdominal pain and a clavicular mass as the initial manifestations of a nonfunctioning malignant pheochromocytoma. Fine needle aspiration of the clavicular mass revealed a metastatic adenocarcinoma. A search for primary site revealed a mass in left adrenal and multiple space occupying lesions in the liver. The aspirations were identical to that from the clavicle. Surgical biopsy of the clavicular mass revealed, features of metastatic pheochromocytoma. Urinary catecholamine was normal. Malignant pheochromocytoma can present with atypical features and guided fine needle aspiration cytology can be a safe diagnostic procedure.

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Malignant Pheochromocytoma Lacking Clinical Features of Catecholamine Excess Until the Late Stage.

Cited by 7 publications

References 19 publications

Feocromocitoma maligno tratado con MIBG I131: una larga supervivencia

Feocromocitoma maligno tratado con MIBG I131: una larga supervivencia

Malignant pheochromocytoma: Hepatectomy for liver metastases

Clavicular metastasis, an initial manifestation of a malignant pheochromocytoma - a case report

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