PHROCHROMOCYTOMAS of the organ of Zuckerkandl are rare tumours and usually are benign. Five (Haug and Baker, 1956;Cook et al., 1960) malignant lesions of these organs and perhaps a sixth (Holsti, 1964) seem to be documented in the literature. Three of these seem to have been pharmacologically active. The purpose of this paper is to present a malignant phzochromocytoma of the organ of Zuckerkandl, with functioning metastases, which showed some rather unusual features. Case Report.-A 33-year-old business man was referred to the Christian Medical College Hospital, Vellore, by his physician for sustained hypertension, refractory to vsrious hypotensive agents. He was admitted to the surgical department on 26th January 1963 with a history of frequent attacks of severe frontal headaches of one year's ducation. Three months prior to admission, these had become worse and were associated with vomiting, anorexia. weakness, loss of weight and dyspncea on moderate exertion. In December, the patient noticed a vague lump in his upper abdomen.Examination revealed a well-nourished young man, with a blood pressure varying between 180/110 and 200/120 mm. Hg. The fundi showed a Grade I1 hypertensive retinopathy. The heart but for an accentuated aortic second sound was considered normal. There was no evidence of failure. A large firm nodular abdominal mass, slightly mobile, was felt in the upper left quadrant. A large varicocele which did not empty on recumbency was present on the left side.His hzmoglobin, differential white cell count and blood urea were within normal limits. Erythrocyte sedimentation rate was 60 mm. during the first hour and 100 mni. during the second hour. Urine showed a trace of albumin with five to six pus cells and two to three R.B.C.'s per high-power field. Chest X-ray was normal. An intravenous pyelogram demonstrated a non-functioning left kidney. A left retrograde pyelogram showed a total obstruction of the ureter at the second lumbar vertebra in the vicinity of a large soft tissue mass occupying the left flank.Through a left thoraco-abdominal incision a tumour about 8 cni. in diameter situated in the left para-aortic region, just proximal t o the bifurcation of the aorta and near the origin of the inferior mesenteric artery, was removed. The ureter was firmly adherent to the postero-lateral surface of this tumour and a nephro-ureterectomy was perforated in addition to the removal of the tumour. There were no enlarged lymph nodes and the liver and other abdominal viscera, including both suprarenal glands, were noted to be normal. The blood-pressure dropped to 90/60 mm. Hg and the systolic pressure was maintained at about 120 mm. by means of a drip containing S mg. of Phenylepherine in 500 ml. of S per cent. dextrose. This could, however, be discontinued an hour after operation. He made an uneventful recovery and was discharged on the 12th post-operative day, relieved of his headaches and feeling quite well. The blood-pressure during the post-operative period varied between 110/70 and 160/100 and at the time ...
