Recurrent pheochromocytoma: intrarenal and pulmonary spread

Update on the optimal management of patients with vascular extension of pheochromocytoma

AIM

Vascular extension of pheochromocytoma is extremely rare but highly resectable. The aim of this study was to review the available information in the literature for patients with this condition.

METHODS

A systematic literature search produced individual data for 29 treated patients with vascular extension of pheochromocytoma mainly to the inferior vena cava.

RESULTS

Out of 29 reported cases, 26 have been treated surgically. Nine of these patients required cardiopulmonary bypass. Two patients died untreated and one patient declined surgical treatment and discharged to follow-up. In 24 patients including nine with primarily missed diagnosis, surgery was documented as curative.

CONCLUSION

Surgeons need to be aware of this extremely rare characteristic feature of pheochromocytoma and indicated medical work-up in order to properly diagnose and manage this challenging group of patients.

Renal paraganglioma: report of a case managed by robotic assisted laparoscopic partial nephrectomy and review of the literature

We describe the pathological and clinical presentation of a rare case of renal paraganglioma occurring as an incidental left renal mass in a 58-year-old woman. The patient underwent robotic assisted laparoscopic partial nephrectomy, which is the first one in the literature.

Prosthetic replacement of the inferior vena cava after resection of a pheochromocytoma

A 52-year-old man had an extensive right adrenal pheochromocytoma with invasion of the pararenal inferior vena cava (IVC). Tumor resection required en bloc resection of the infrahepatic IVC. The right kidney was not involved with tumor. Reconstruction of the IVC was performed with an externally supported, expanded polytetrafluoroethylene graft with reimplantation of the right renal veins into the prosthesis. Postoperative patency of the IVC graft and renal veins was confirmed by venacavography and color-flow duplex scanning. This latter technique has been used to document interval patency of the IVC graft 3, 6, and 12 months after surgery.