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Gabiache G, Zadro C, Rozenblum L, Vezzosi D, Mouly C, Thoulouzan M, Guimbaud R, Otal P, Dierickx L, Rousseau H, Trepanier C, Dercle L, Mokrane FZ. Image-Guided Precision Medicine in the Diagnosis and Treatment of Pheochromocytomas and Paragangliomas. Cancers (Basel) 2023; 15:4666. [PMID: 37760633 PMCID: PMC10526298 DOI: 10.3390/cancers15184666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
In this comprehensive review, we aimed to discuss the current state-of-the-art medical imaging for pheochromocytomas and paragangliomas (PPGLs) diagnosis and treatment. Despite major medical improvements, PPGLs, as with other neuroendocrine tumors (NETs), leave clinicians facing several challenges; their inherent particularities and their diagnosis and treatment pose several challenges for clinicians due to their inherent complexity, and they require management by multidisciplinary teams. The conventional concepts of medical imaging are currently undergoing a paradigm shift, thanks to developments in radiomic and metabolic imaging. However, despite active research, clinical relevance of these new parameters remains unclear, and further multicentric studies are needed in order to validate and increase widespread use and integration in clinical routine. Use of AI in PPGLs may detect changes in tumor phenotype that precede classical medical imaging biomarkers, such as shape, texture, and size. Since PPGLs are rare, slow-growing, and heterogeneous, multicentric collaboration will be necessary to have enough data in order to develop new PPGL biomarkers. In this nonsystematic review, our aim is to present an exhaustive pedagogical tool based on real-world cases, dedicated to physicians dealing with PPGLs, augmented by perspectives of artificial intelligence and big data.
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Affiliation(s)
- Gildas Gabiache
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Charline Zadro
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Laura Rozenblum
- Department of Nuclear Medicine, Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - Delphine Vezzosi
- Department of Endocrinology, Rangueil University Hospital, 31400 Toulouse, France
| | - Céline Mouly
- Department of Endocrinology, Rangueil University Hospital, 31400 Toulouse, France
| | | | - Rosine Guimbaud
- Department of Oncology, Rangueil University Hospital, 31400 Toulouse, France
| | - Philippe Otal
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Lawrence Dierickx
- Department of Nuclear Medicine, IUCT-Oncopole, 31059 Toulouse, France;
| | - Hervé Rousseau
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Christopher Trepanier
- New York-Presbyterian Hospital/Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Laurent Dercle
- New York-Presbyterian Hospital/Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Fatima-Zohra Mokrane
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
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Nakayama T, Ito K, Inagaki F, Kobayashi M, Tanabe A, Mihara F, Takemura N, Kokudo N. Repeat hepatectomy for massive liver metastases from pheochromocytoma: a case report. Clin J Gastroenterol 2023; 16:457-463. [PMID: 36943552 DOI: 10.1007/s12328-023-01784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
In malignant pheochromocytoma, the survival benefit of metastasectomy remains unclear. However, excessive catecholamines secreted from pheochromocytomas can cause cardiovascular and cerebrovascular complications. Debulking metastasectomy can be performed to reduce excess catecholamine secretion when curative resection is impossible. We present a case of metastatic pheochromocytoma to the liver, wherein a significant reduction in catecholamine secretion was achieved by repeat debulking hepatectomy. A 62-year-old woman who had undergone left adrenalectomy for primary pheochromocytoma 10 years prior to our surgical management, had multiple liver metastases of pheochromocytoma. Curative hepatectomy was infeasible because of insufficient remnant liver volume; thus, debulking hepatectomy was conducted. Preoperatively, increased doses of alpha-blockers and catecholamine synthesis inhibitors were administered. Nevertheless, substantial fluctuations in blood pressure and massive hemorrhage were observed intraoperatively. Eight months after the initial hepatectomy, repeat hepatectomy for the remnant lesions was performed due to the worsening of catecholamine levels and catecholamine-related symptoms. The patient survived, with serum catecholamines remaining within the normal range after repeat hepatectomy. Repeat debulking hepatectomy for metastatic pheochromocytoma to the liver is a feasible treatment strategy to effectively decrease catecholamine secretion and alleviate the symptoms thereof. However, special attention should be paid to perioperative catecholamine management and intraoperative surgical techniques.
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Affiliation(s)
- Toshihiro Nakayama
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Michi Kobayashi
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
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Muacevic A, Adler JR. Late Local and Distant Recurrence of Apparently Benign Paraganglioma. Cureus 2022; 14:e29874. [PMID: 36348854 PMCID: PMC9629821 DOI: 10.7759/cureus.29874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/24/2022] Open
Abstract
Paraganglioma-pheochromocytoma (PPGLs) are relatively rare catecholamine-secreting tumors of chromaffin origin. Due to the sympathetic effects of catecholamine excess, their presentation may range from non-specific symptoms to dangerous hypertensive crises. We present the case of a 36-year-old lady with recurrent paraganglioma (PGL) who presented in emergency with hypertensive crisis. She had a history of surgery for left-sided PGL 18 years earlier. Imaging showed local recurrence with pulmonary metastases and blood biochemistry showed raised urinary metanephrines. In view of her poor general condition, we undertook a staged surgical approach for management. She first underwent en-bloc excision of recurrent PGL with left nephrectomy. Nine weeks later, she underwent a pulmonary metastasectomy. This staged surgical approach resulted in the stabilization of blood pressure and normalization of urinary catecholamine. Although most of these tumors are indolent by nature, this case highlights the metastatic potential of apparently benign PGL. This case explores the possibility of a staged surgical approach in a high-risk patient and emphasizes the need for long-term follow-up in these cases.
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Hooshyari A, Tyson M, Rice M. Paraganglioma (pheochromocytoma) of the urinary bladder: A systematic review with a diagnostic, management and treatment algorithm. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221090329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Paraganglioma of the urinary bladder is a rare but well-documented tumour. Herein, we provide the largest, comprehensive systematic review of the literature and aim to increase familiarity with this rare but significant neoplasm. Methods: A systematic review of the literature was conducted on the NCBI PubMed database. The search criteria were not limited to any specific years or languages. There were 418 articles between January 1953 and August 2020, of which 255 case reports were selected. Results: Paragangliomas of the urinary bladder most commonly occurred in Caucasians in the fifth decade of life, most commonly presenting with haematuria and variations of ‘micturition attacks’. Eighty percent of tumours were functionally active. The mucosa was normal in 91% of patients. In all, 25% of tumours were treated with transurethral resection alone, 65% had partial cystectomy and 5% had radical cystectomy. Alpha-blockers were administered pre-operatively in 38% of patients and the risk of intra-operative hypertensive crisis was over three times greater in those who did not receive an alpha-blocker. The tumour was confined to the bladder in 75% of cases. Metastasis occurred in 20% of cases, most commonly to iliac nodes. The mean follow-up time was 26.5 months. In cases that documented follow-up, 18.6% had recurrence, most commonly in lymph nodes and bone. Conclusion: All patients presenting with micturition attacks or haematuria with a computed tomography showing an enhancing, well-defined submucosal bladder lesion and/or cystoscopy showing a lesion with normal overlying mucosa should be worked up for a possible paraganglioma of the urinary bladder. Level of evidence: Not applicable
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Affiliation(s)
- Ali Hooshyari
- Urology Department, Auckland City Hospital, Auckland District Health Board, New Zealand
| | - Matthew Tyson
- Urology Department, Auckland City Hospital, Auckland District Health Board, New Zealand
| | - Michael Rice
- Urology Department, Auckland City Hospital, Auckland District Health Board, New Zealand
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Łoń I, Kunikowska J, Jędrusik P, Góra J, Toutounchi S, Placha G, Gaciong Z. Familial SDHB gene mutation in disseminated non-hypoxia-related malignant paraganglioma treated with [ 90Y]Y/[ 177Lu]Lu- DOTATATE. Intractable Rare Dis Res 2021; 10:207-213. [PMID: 34466344 PMCID: PMC8397825 DOI: 10.5582/irdr.2021.01047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/17/2021] [Accepted: 05/18/2021] [Indexed: 11/05/2022] Open
Abstract
Familial paraganglioma may be related to mutations in succinate dehydrogenase (SDH) enzyme complex genes. Among patients with hereditary paraganglioma, SDH subunit B (SDHB) gene mutations are associated with the highest morbidity and mortality related to a higher malignancy rate. We report a family with the c.689G>A (p.Arg230His) mutation in the SDHB gene identified in two family members, a father and his daughter. While the 14-year-old daughter had no evidence of clinical disease, recurrent and later disseminated [131I]metaiodobenzylguanidine uptake-negative head and neck paraganglioma with multiple bone metastases developed in the father who underwent peptide receptor radionuclide therapy with [90Y]Y/[177Lu]Lu-dodecane tetraacetic acid octreotate (DOTATATE) at the time of the genetic diagnosis. This treatment was repeated 6 years later due to disease progression and the patient, who is currently 49 years old, remains alive and in good overall clinical condition at 8 years of follow-up after the original presentation at our unit. The growing armamentarium of imaging methods available for such patients may inform decision making regarding choice of the optimal treatment approach, potentially contributing to improved outcomes.
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Affiliation(s)
- Izabela Łoń
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Kunikowska
- Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Jędrusik
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
- Address correspondence to:P i o t r J ę d r u s i k , D e p a r t m e n t o f I n t e r n a l M e d i c i n e , Hypertension and Vascular Diseases, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland. E-mail:
| | - Jarosław Góra
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Sadegh Toutounchi
- Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Placha
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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Endocrine hypertension secondary to adrenal tumors: clinical course and predictive factors of clinical remission. Langenbecks Arch Surg 2021; 406:2027-2035. [PMID: 34159439 DOI: 10.1007/s00423-021-02245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Endocrinopathies constitute ~ 10% of secondary hypertension (SH) etiologies. Primary aldosteronism, pheochromocytoma (PHEO), and Cushing's syndrome are common causes. Early identification and treatment result in resolution/improvement of SH. The aim of this study was to characterize the clinical course, outcomes, and remission-associated prognostic factors of SH related to adrenal tumors. METHODS Retrospective cohort study including patients with SH who underwent adrenalectomy from 2000 to 2019. Postoperative outcomes were analyzed. Remission was defined as normalization of blood pressure without drug use. RESULTS Eighty-three patients with SH were included. Mean ± SD age was 38.8 ± 14.2 years and 75.9% were women. Diagnosis was PHEO in 35 patients (42.2%), aldosteronoma (APA) in 28 (33.7%), cortisol producing adenoma (CPA) in 16 (19.3%), and ACTH-dependent Cushing's in 4 (4.8%). Laparoscopic adrenalectomy was performed in 81 (97.6%) patients. Mean ± SD follow-up was 57.4 ± 49.6 months (range 1-232). Surgical morbidity occurred in 7.2% of patients and there was no mortality. Remission of SH occurred in 61(73.5%): 100% of ACTH-dependent Cushing's, 85.7% of PHEO, 68.8% of CPA, and 57.1% of APA. Biochemical phenotype and the combination of larger tumor size, number of antihypertensive drugs, male gender, older age, obesity, and preoperative SH for more than 5 years were associated with less likely clinical remission in patients with APA (p = 0.004), CPA (p < 0.0001), and PHEO (p < 0.0001). CONCLUSION SH remission rates are 57-100% after adrenalectomy. Several prognostic factors could be used to predict SH control. Adrenalectomy provides good clinical outcome and must be considered a treatment option in all surgical candidates.
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Surgical resection for liver metastasis and local recurrence of pheochromocytoma 16 years after primary surgery: A case report. Int J Surg Case Rep 2021; 81:105712. [PMID: 33684645 PMCID: PMC7941035 DOI: 10.1016/j.ijscr.2021.105712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Pheochromocytoma is a rare tumor with malignant potential. Distant metastases are almost always unresectable, and carry a poor prognosis. Early detection and complete resection resulted in good outcomes.
Introduction and importance Pheochromocytomas arise from the adrenal medulla and are rare. Pheochromocytomas metastasize to bone, lung and liver, and surgery might be the curative treatment. However, few cases are detected when they are resectable lesions because of difficulty in diagnosis and rapid growth. We herein report a patient who underwent resection of liver metastasis and local recurrence of pheochromocytoma. Case presentation A 74-year-old woman visited our hospital for treatment for liver and retroperitoneal tumors. She had undergone left adrenal gland resection for pheochromocytoma 16 years earlier. Eleven years after primary surgery, breast cancer was diagnosed and resected. During the breast cancer follow-up, a liver tumor was identified with computed tomography. Breast cancer recurrence and metastasis were considered, so chemotherapy was administered first. However, the liver tumor gradually enlarged, and another lesion appeared in the retroperitoneum. The tumors were diagnosed as pheochromocytoma recurrence using 123I-metaiodobenzylguanidine scintigraphy, and she underwent resection of the local recurrence and liver metastasis. She was discharged on postoperative day 25 without complications, and no evidence of recurrence occurred more than 3.5 years postoperatively. Clinical discussion All pheochromocytomas have metastatic potential; however, there are no reliable markers to predict malignancy. Early detection of recurrence by regular imaging and complete resection are important in the treatment. If the recurrence was oligometastasis and tumor growth is slow, surgical resection may be eligible. Conclusion A favorable outcome resulted from complete resection for liver metastasis and local recurrence of pheochromocytoma.
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Iglesias P, Santacruz E, García-Sancho P, Marengo AP, Guerrero-Pérez F, Pian H, Fajardo C, Villabona C, Díez JJ. Pheochromocytoma: A three-decade clinical experience in a multicenter study. Rev Clin Esp 2021; 221:18-25. [PMID: 32646754 DOI: 10.1016/j.rce.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/13/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). DESIGN AND METHODS A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. RESULTS A total of 106 patients (61 [57.5%] women, mean age 52.3 ± 14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ± 14.2 years vs. 54.5 ± 13.9 years, p<.001). Familial PCCs were more frequently associated with MEN2A (n=8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3cm (3-6cm); 27.7% of the patients had tumors ≥6cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4cm [2.4-5.0cm] vs. 5.6cm [4.0-7.0cm], p<.001). Scintigraphy by 123I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). CONCLUSIONS PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low.
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Affiliation(s)
- P Iglesias
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España; Servicio de Endocrinología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - E Santacruz
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P García-Sancho
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A P Marengo
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F Guerrero-Pérez
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - H Pian
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Fajardo
- Servicio de Endocrinología, Hospital Universitario de La Ribera, Alcira, Valencia, España
| | - C Villabona
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J J Díez
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España; Servicio de Endocrinología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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9
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Iglesias P, Santacruz E, García-Sancho P, Marengo AP, Guerrero-Pérez F, Pian H, Fajardo C, Villabona C, Díez JJ. Pheochromocytoma: A three-decade clinical experience in a multicenter study. Rev Clin Esp 2020; 221:18-25. [PMID: 33998473 DOI: 10.1016/j.rceng.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). DESIGN AND METHODS A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. RESULTS A total of 106 patients (61 [57.5%] women, mean age 52.3 ± 14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ± 14.2 years vs 54.5 ± 13.9 years, p < .001). Familial PCCs were more frequently associated with MEN2A (n = 8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3 cm (3-6 cm); 27.7% of the patients had tumors ≥6 cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4 cm [2.4-5.0 cm] vs 5.6 cm [4.0-7.0 cm], p < .001). Scintigraphy by ¹²³I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). CONCLUSIONS PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low.
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Affiliation(s)
- P Iglesias
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España; Servicio de Endocrinología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - E Santacruz
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P García-Sancho
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A P Marengo
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F Guerrero-Pérez
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - H Pian
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Fajardo
- Servicio de Endocrinología, Hospital Universitario de La Ribera, Alcira, Valencia, España
| | - C Villabona
- Servicio de Endocrinología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J J Díez
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España; Servicio de Endocrinología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Ueda M, Shoji F, Kozuma Y, Toyokawa G, Yamazaki K, Momosaki S, Takeo S. Resection of Pulmonary Metastases 12 Years after Initial Surgery for a Benign Pheochromocytoma. Ann Thorac Cardiovasc Surg 2020; 28:232-235. [PMID: 33071244 PMCID: PMC9209893 DOI: 10.5761/atcs.cr.20-00162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe a rare case of newly discovered pulmonary metastases and surgical confirmation 12 years after initial surgery for a pheochromocytoma. A 61-year-old asymptomatic man was referred because of an abnormal shadow in the right lung field upon chest radiography. Computed tomography (CT) showed two well-demarcated tumors in the basal segment of the right lung. Twelve years previously, he underwent right adrenalectomy and was pathologically diagnosed as having a benign pheochromocytoma. Thereafter, he received a medical check-up annually. To confirm the diagnosis of two pulmonary tumors, video-assisted thoracic surgery was done and wedge resection of the right lower lobe completed. Pathology studies revealed these tumors as pulmonary metastases from the pheochromocytoma, which indicated that the true diagnosis was a malignant pheochromocytoma. Patients with a benign pheochromocytoma should continue to undergo careful monitoring for a long time after the initial surgical procedure. Thoracic surgeons should be aware of the possibility of pulmonary metastases even if >10 years have passed since initial resection of a benign pheochromocytoma.
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Affiliation(s)
- Michiko Ueda
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Fumihiro Shoji
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Yuka Kozuma
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Gouji Toyokawa
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Seiya Momosaki
- Department of Pathology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
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Yankelevich GR, Piraino J, Akanda S, Edwards DC, Gerges M, Snow ZA, McGreen B, Levy J, Ciocca V, Hagg MJ. Paraganglioma of the Spermatic Cord With Spinal Metastasis: A Case Report. Urology 2020; 143:e7-e11. [PMID: 32505620 DOI: 10.1016/j.urology.2020.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/25/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
A 40-year-old male with presented to the clinic with the chief complaint of right inguinal pain radiating to his right testicle and right thigh with no history of trauma, fever, chills, dysuria, hematuria, or unprotected sexual activity. Physical exam revealed right testicular tenderness with no palpable abnormality of the bilateral testes or spermatic cords. Scrotal ultrasound was performed and was unremarkable for testicular or other intrascrotal pathology. Concurrently, chronic low back pain had prompted a lumbar CT to be performed, which was indeterminate, but subsequent lumbar MRI performed three months later revealed abnormal signals in the vertebral bodies of T12, L3, and L5, concerning for occult metastatic disease or multiple myeloma. PET-CT was performed revealing hypermetabolic lesions throughout the axial skeleton and, most notably, hypermetabolic lesions in the left inguinal and left upper scrotum. At this time, about 4 months after the original visit, physical exam revealed a palpable mobile mass in the left upper scrotum that was distinct from the left testicle, and another mass palpable near the left inguinal ring.
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Affiliation(s)
| | - Javier Piraino
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Shawon Akanda
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
| | | | - Michael Gerges
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Zachary A Snow
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Brian McGreen
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Jason Levy
- Department of Urology, Main Line Health, Philadelphia, PA
| | | | - Michael J Hagg
- Department of Urology, Main Line Health, Philadelphia, PA
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Zhang B, Fu Z, Liu L, Qiao B, Liu C. Non-functional paraganglioma of urinary bladder managed by transurethral resection. Int Braz J Urol 2019; 45:910-915. [PMID: 31038858 PMCID: PMC6844347 DOI: 10.1590/s1677-5538.ibju.2018.0604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/30/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB. This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT). Materials and Methods The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment. Results The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up period of 36.4 ± 24.8 months. Conclusion Complete TURBT is a safe and efficient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confirmation. Long-term follow-up is recommended for patients with non-functional PUB.
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Affiliation(s)
- Baochao Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhenrui Fu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Liwei Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Baomin Qiao
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chunyu Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Angelousi A, Peppa M, Chrisoulidou A, Alexandraki K, Berthon A, Faucz FR, Kassi E, Kaltsas G. Malignant Pheochromocytomas/Paragangliomas and Ectopic Hormonal Secretion: A Case Series and Review of the Literature. Cancers (Basel) 2019; 11:E724. [PMID: 31137729 PMCID: PMC6563134 DOI: 10.3390/cancers11050724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Malignant pheochromocytomas (PCs) and paragangliomas (PGLs) are rare neuroendocrine neoplasms defined by the presence of distant metastases. There is currently a relatively paucity of data regarding the natural history of PCs/PGLs and the optimal approach to their treatment. We retrospectively analyzed the clinical, biochemical, imaging, genetic and histopathological characteristics of fourteen patients with metastatic PCs/PGLs diagnosed over 15 years, along with their response to treatment. Patients were followed-up for a median of six years (range: 1-14 years). Six patients had synchronous metastases and the remaining developed metastases after a median of four years (range 2-10 years). Genetic analysis of seven patients revealed that three harbored succinate dehydrogenase subunit B/D gene (SDHB/D) mutations. Hormonal hypersecretion occurred in 70% of patients; normetanephrine, either alone or with other concomitant hormones, was the most frequent secretory component. Patients were administered multiple first and subsequent treatments including surgery (n = 12), chemotherapy (n = 7), radionuclide therapy (n = 2) and radiopeptides (n = 5). Seven patients had stable disease, four had progressive disease and three died. Ectopic hormonal secretion is rare and commonly encountered in benign PCs. Ectopic secretion of interleukin-6 in one of our patients, prompted a literature review of ectopic hormonal secretion, particularly from metastatic PCs/PGLs. Only four cases of metastatic PC/PGLs with confirmed ectopic secretion of hormones or peptides have been described so far.
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Affiliation(s)
- Anna Angelousi
- Department of Internal Medicine, Unit of Endocrinology, National and Kapodistrian University of Athens, Laiko hospital, 11527 Goudi, Greece.
| | - Melpomeni Peppa
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Haidari, Greece.
| | - Alexandra Chrisoulidou
- Unit of Endocrinology, Theagenio Cancer Hospital, 2 Al Simeonidi Str., 54007 Thessaloniki, Greece.
| | - Krystallenia Alexandraki
- st Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko hospital, 11527 Goudi, Athens, Greece.
| | - Annabel Berthon
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Fabio Rueda Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Eva Kassi
- Department of Internal Medicine, Unit of Endocrinology, National and Kapodistrian University of Athens, Laiko hospital, 11527 Goudi, Greece.
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Goudi, Athens, Greece.
| | - Gregory Kaltsas
- st Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Laiko hospital, 11527 Goudi, Athens, Greece.
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Andrade MDO, Cunha VSD, Oliveira DCD, Moraes OLD, Lofrano-Porto A. What determines mortality in malignant pheochromocytoma? – Report of a case with eighteen-year survival and review of the literature. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:264-269. [PMID: 29768630 PMCID: PMC10118982 DOI: 10.20945/2359-3997000000033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/19/2018] [Indexed: 11/23/2022]
Abstract
Pheochromocytoma (PCC) is a tumor derived from adrenomedullary chromaffin cells. Prognosis of malignant PCC is generally poor due to local recurrence or metastasis. We aim to report a case of malignant PCC with 18-year survival and discuss which factors may be related to mortality and long-term survival in malignant pheochromocytoma. The patient, a 45-year-old man, reported sustained arterial hypertension with paroxysmal episodes of tachycardia, associated with head and neck burning sensation, and hand and foot tremors. Diagnosis of PCC was established biochemically and a tumor with infiltration of renal parenchyma was resected. No genetic mutation or copy number variations were identified in SDHB, SDHD, SDHC, MAX and VHL. Over 18 years, tumor progression was managed with 131I-MIBG (iodine-metaiodobenzylguanidine) and 177Lutetium-octreotate therapy. Currently, the patient is asymptomatic and presents sustained stable disease, despite the presence of lung, para-aortic lymph nodes and femoral metastases. Adequate response to treatment with control of tumor progression, absence of significant cardiovascular events and other neoplasms, and lack of mutations in the main predisposing genes reported so far may be factors possibly associated with the prolonged survival in this case. Early diagnosis and life-long follow-up in patients with malignant pheochromocytoma are known to be crucial in improving survival.
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Iwamoto G, Kawahara T, Tanabe M, Ninomiya S, Takamoto D, Mochizuki T, Kuroda S, Takeshima T, Izumi K, Hattori Y, Teranishi JI, Yumura Y, Miyoshi Y, Uemura H. Paraganglioma in the bladder: a case report. J Med Case Rep 2017; 11:306. [PMID: 29084607 PMCID: PMC5663097 DOI: 10.1186/s13256-017-1473-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Paraganglioma is an extra site of pheochromocytoma. Paraganglioma in the bladder is a very rare disease accounting for 0.06% of all bladder tumors. Case presentation A 77-year-old Japanese man was referred to our department for the further examination of a bladder tumor detected on preoperative computed tomography of his gastric cancer. Cystoscopy revealed a submucosal tumor in the upper area of his bladder, so transurethral resection of the bladder tumor was performed. During transurethral resection of the bladder tumor, his blood pressure sharply increased, and a pathological examination showed paraganglioma in his bladder. Postoperative I-123-metaiodobenzylguanidine scintigraphy detected a higher intake of his bladder tumor. Laboratory examinations showed a slightly increased noradrenaline level of 530 pg/ml and reduced platelet count at 167,000/μL. Based on the progression of his gastric cancer, no additional therapy was performed on his bladder tumor. Eight months after surgery, he died from aspiration pneumonitis. Conclusions Here we report a rare case of paraganglioma in the bladder. We discuss paraganglioma based on previous studies.
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Affiliation(s)
- Genta Iwamoto
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
| | - Mikiko Tanabe
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Sahoko Ninomiya
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Daiji Takamoto
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Mochizuki
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinnosuke Kuroda
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Teppei Takeshima
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Koji Izumi
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hattori
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-Ichi Teranishi
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Yumura
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroji Uemura
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
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Zhai H, Ma X, Nie W, Li H, Peng C, Li X, Zhang Y, Zhang X. Paraganglioma of the Urinary Bladder: A Series of 22 Cases in a Single Center. Clin Genitourin Cancer 2017; 15:e765-e771. [PMID: 28688872 DOI: 10.1016/j.clgc.2017.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Paraganglioma of the urinary bladder (PUB) is rare in bladder cancer, and currently, a study examining large number of cases from a single center has not been reported. This study aimed to present the clinical features, treatments, pathological characteristics, and prognosis of PUB. PATIENTS AND METHODS From January 2006 to June 2016, 22 patients were pathologically diagnosed with PUB in our hospital. Their clinical records, operative notes, pathological reports, and follow-up records were retrospectively reviewed. RESULTS The incidence of PUB in patients with bladder cancer was 0.92%. The mean age at diagnosis was 49.8 ± 14.6 years (range, 16-76 years) and the male to female ratio was 1:1. Fourteen cases (63.6%) were functional. The common indicative symptoms included hematuria (36.4%), hypertension (31.8%), micturition syncope (27.3%), headache (18.2%), and palpitation (13.6%). All neoplasms were completely resected via transurethral resection of bladder tumor (TURBT), en bloc transurethral resection with thulium-yag laser, or partial cystectomy. Most PUB samples were positive for immunohistochemical (IHC) staining markers such as chromogranin A (CgA), Synaptophysin (Syn), CD56, and S-100 protein, while negative for IHC markers such as cytokeratins (CKs) and Melan A. According to pathological reports, 72.7% of PUB cases were at stage T2, 18.2% at T3, and 9.1% at T4. Two cases (9.1%) with metastasis were malignant. Two patients (9.1%) were lost during follow-up, and the remaining 20 patients were followed up for a period of 67.8 ± 38.5 months (range, 6-130 months). Among them, 16 patients (80%) recovered after the surgery, 1 patient (5%) died of natural causes. PUB recurred in 3 patients (15%), and 1 patient among them died of PUB. CONCLUSION Despite the rarity, PUB should be suspected in patients with unexplained symptoms such as micturition syncope, hematuria, hypertension, headache, or palpitation. Surgery and adjuvant therapies are effective treatments for PUB. Compared with open surgery, laparoscopic partial cystectomy and robot-assisted laparoscopic partial cystectomy are advantageous in the treatment of PUB. Long-term follow-up is recommended for patients with PUB.
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Affiliation(s)
- Hongyun Zhai
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Wenyuan Nie
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Cheng Peng
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Xintao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Yu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China.
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Ramírez-Plaza CP, Cárdenas EMS, Humanes RS. Multiple nodal locoregional recurrence of pheochromocytoma. Int J Surg Case Rep 2015; 13:69-72. [PMID: 26117450 PMCID: PMC4529647 DOI: 10.1016/j.ijscr.2015.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/24/2015] [Accepted: 06/07/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Malignancy is present in 10% of pheochromocytomas (PCC) and is defined as local/vascular infiltration of surrounding tissues or the presence of chromaffin cells deposits in distant organs. The presence of isolated nodal recurrence is very rare and only 7 cases have been reported in the medical literature. PRESENTATION OF THE CASE The case of a 32-y male with a symptomatic recurrence of a previously operated (2-years ago) PCC is presented. Radiological and functional imaging studies confirmed the presence of multiple nodules in the surgical site. A radical left nephrectomy with extensive lymphatic clearance in order to get an R0 resection was performed. The pathologist confirmed the diagnosis of massive locoregional nodal invasion. DISCUSSION A detailed histological report and a thorough genetic study must be considered in every operated PCC in order to identify mutations and profiles of risk for malignancy. When recurrence or metastastic disease is suspected, imaging and functional exams are done in order to obtain a proper staging. Radical surgery for the metastatic disease is the only treatment that may provide prolonged survival. If an R0 resection is not possible, then a debulking surgery is a good option when the benefit/risk ratio is acceptable. CONCLUSION Isolated lymph nodal recurrence is very rare in malignant PCC, with only 7 cases previously published. The role of surgery is essential to get long-term survival because provides clinical and functional control of the disease.
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Affiliation(s)
- César Pablo Ramírez-Plaza
- General and Digestive Surgery Service. Hospital Quirón Málaga. Avenida Imperio Argentina, n°1, Málaga, CP 29004, Spain.
| | | | - Rocío Soler Humanes
- General and Digestive Surgery Service. Hospital Quirón Málaga. Avenida Imperio Argentina, n°1, Málaga, CP 29004, Spain
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Han YJ, Ock SY, Kim EJ, Shin HS, Jung YS, Rim H. Thunderclap-like headache triggered by micturition and angina as an initial manifestation of bladder pheochromocytoma. A case report. SAO PAULO MED J 2015; 133:154-9. [PMID: 25424777 PMCID: PMC10496642 DOI: 10.1590/1516-3180.2013.6890002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 03/13/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis and angina. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. CASE REPORT This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by micturition and angina as an initial manifestation. CONCLUSION This case study suggests that thunderclap headache and angina occurring concurrently with sudden blood pressure elevation during or immediately after micturition are important diagnostic clues for bladder pheochromocytoma.
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Affiliation(s)
- You Jin Han
- MD. Resident Physician, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | - So Young Ock
- MD. Resident Physician, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | - Eun Jung Kim
- MD. Resident Physician, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | - Ho Sik Shin
- MD. Assistant Professor, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeon Soon Jung
- MD, PhD. Associate Professor, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hark Rim
- MD, PhD. Professor, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Malignant paraganglioma of the bladder: A case report and review of the literature. Pathol Res Pract 2015; 211:183-8. [DOI: 10.1016/j.prp.2014.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/05/2014] [Accepted: 10/23/2014] [Indexed: 11/23/2022]
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Ranaweera M, Chung E. Bladder paraganglioma: A report of case series and critical review of current literature. World J Clin Cases 2014; 2:591-595. [PMID: 25325073 PMCID: PMC4198415 DOI: 10.12998/wjcc.v2.i10.591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/02/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
Extra-adrenal chromaffin cell-related tumours or paragangliomas are rare, especially in the bladder. In this article, we reported three different clinical cases of bladder paraganglioma, followed by a review of current literature on the pathophysiology and management of bladder paraganglioma. Case 1 involved a 23 years old female patient who complained of a 10-year history of micturition-related headaches, palpitations and diaphoresis; while in case 2, a 58 years old female patient presented with history of painless haematuria and an incidentally diagnosis of a functioning paraganglioma during endoscopic transurethral resection of bladder tumour; and lastly in case 3, a 54 years old male renal transplant recipient was referred to the urology outpatient with a suspicious bladder mass found incidentally on routine transplant workshop.
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Fishbein L, Nathanson KL. Pheochromocytoma and paraganglioma: understanding the complexities of the genetic background. Cancer Genet 2012; 205:1-11. [PMID: 22429592 DOI: 10.1016/j.cancergen.2012.01.009] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/17/2012] [Accepted: 01/19/2012] [Indexed: 12/29/2022]
Abstract
Pheochromocytomas and paragangliomas (PCC/PGL) are tumors derived from the adrenal medulla or extra-adrenal ganglia, respectively. They are rare and often benign tumors that are associated with high morbidity and mortality due to mass effect and high circulating catecholamines. Although most PCCs and PGLs are thought to be sporadic, over one third are associated with 10 known susceptibility genes. Mutations in three genes causing well characterized tumor syndromes are associated with an increased risk of developing PCCs and PGLs, including VHL (von Hippel-Lindau disease), NF1 (Neurofibromatosis Type 1), and RET (Multiple Endocrine Neoplasia Type 2). Mutations in any of the succinate dehydrogenase (SDH) complex subunit genes (SDHA, SDHB, SDHC, SDHD) can lead to PCCs and PGLs with variable penetrance, as can mutations in the subunit cofactor, SDHAF2. Recently, two additional genes have been identified, TMEM127 and MAX. Although these tumors are rare in the general population, occurring in two to eight per million people, they are more commonly associated with an inherited mutation than any other cancer type. This review summarizes the known germline and somatic mutations leading to the development of PCC and PGL, as well as biochemical profiling for PCCs/PGLs and screening of mutation carriers.
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Affiliation(s)
- Lauren Fishbein
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Malignant pheochromocytomas and paragangliomas: a diagnostic challenge. Langenbecks Arch Surg 2011; 397:155-77. [PMID: 22124609 DOI: 10.1007/s00423-011-0880-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 11/14/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Malignant pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare disorders arising from the adrenal gland, from the glomera along parasympathetic nerves or from paraganglia along the sympathetic trunk. According to the WHO classification, malignancy of PCCs and PGLs is defined by the presence of metastases at non-chromaffin sites distant from that of the primary tumor and not by local invasion. The overall prognosis of metastasized PCCs/PGLs is poor. Surgery offers currently the only change of cure. Preferably, the discrimination between malignant and benign PCCs/PGLs should be made preoperatively. METHODS This review summarizes our current knowledge on how benign and malignant tumors can be distinguished. CONCLUSION Due to the rarity of malignant PCCs/PGLs and the obvious difficulties in distinguishing benign and malignant PCCs/PGLs, any patient with a PCC/PGL should be treated in a specialized center where a multidisciplinary setting with specialized teams consisting of radiologists, endocrinologist, oncologists, pathologists and surgeons is available. This would also facilitate future studies to address the existing diagnostic and/or therapeutic obstacles.
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[Late bone metastases of a pheochromocytoma]. Rev Med Interne 2011; 31:772-5. [PMID: 20884095 DOI: 10.1016/j.revmed.2010.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/13/2010] [Accepted: 07/19/2010] [Indexed: 11/21/2022]
Abstract
Pheochromocytoma is a usually benign tumor of chromaffin tissue (90% of cases). We report a 77-year-old patient with a past medical history of surgically removed pheochromocytoma that was considered to be "benign", who presented with secondary bone metastases 5 years later. A treatment combining radiation and interferon allowed to control the metastatic lesions. The possibility of late metastatic extension in patients with pheochromocytoma should be kept in mind.
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Lin WC, Chen SC, Chuang YT, Kuo KL, Huang KH. Stathmin Immunoreactivity in Phaeochromocytomas and Paragangliomas: Differential Expression Between Benign and Malignant Neoplasms. Asian J Surg 2011; 34:15-22. [DOI: 10.1016/s1015-9584(11)60013-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/27/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022] Open
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Oderda M, Michelon F, Appendino M, Gallo M, Senetta R, Pacchioni D, Tizzani A, Gontero P. Primary bladder phaeochromocytoma diagnosed by a vet. ACTA ACUST UNITED AC 2010; 44:186-9. [PMID: 20180653 DOI: 10.3109/00365591003639202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bladder phaeochromocytomas are rare neuroendocrine neoplasms whose diagnosis can be missed in spite of their rather suggestive presentation. It is mandatory to collect a thorough medical history and to recognize their typical symptoms. This study reports the case of a woman, treated for hypertensive crisis, who was diagnosed with bladder phaeochromocytoma thanks to a vet noting her fainting after micturition.
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Affiliation(s)
- Marco Oderda
- Department of Urology, University of Turin, Molinette Hospital, Corso Dogliotti 14, Turin, Italy
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Noda T, Nagano H, Miyamoto A, Wada H, Murakami M, Kobayashi S, Marubashi S, Takeda Y, Dono K, Umeshita K, Wakasa K, Monden M. Successful outcome after resection of liver metastasis arising from an extraadrenal retroperitoneal paraganglioma that appeared 9 years after surgical excision of the primary lesion. Int J Clin Oncol 2009; 14:473-7. [PMID: 19856061 DOI: 10.1007/s10147-008-0872-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 12/23/2008] [Indexed: 10/20/2022]
Abstract
A 54-year-old man underwent surgery for excision of a retroperitoneal tumor that measured 12 cm in diameter, and histopathological examination revealed the tumor was an extraadrenal retroperitoneal paraganglioma. He presented 9 years later with epigastric discomfort. Abdominal ultrasound showed a solitary liver tumor. The diagnosis, based on radiological workup, was metastatic paraganglioma. The tumor was surgically resected and the histological findings resembled those of the primary tumor. The patient has been followed up for 3 years and remains recurrence-free. Surgical resection is an effective treatment approach for primary and secondary paragangliomas, but the resectability of liver metastatic lesions is usually low, although complete resection with a wide surgical margin was possible in this patient. This case suggests that a good prognosis after the resection of hepatic metastasis depends not only on the curative resection of the metastatic lesion but also on the tumor characteristics, such as slow growth or low aggressiveness.
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Affiliation(s)
- Takehiro Noda
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Abstract
Pheochromocytoma (PCC) is a rare disease, mainly sporadic, but also associated with some familial disorders, with a malignancy frequency of approximately 10%. Only the presence of distant metastases, derived from large pleomorphic chromaffin cells, is widely accepted as a criterion of malignancy. Variable symptoms may be caused by production and release of catecholamines. Since there is no curative treatment for malignant PCC and due to its unfavorable prognosis, assuring quality of life is one of the main therapeutic objectives. Besides a long-term medical treatment of symptoms using selective alpha-1 blockers and nonselective, noncompetitive alpha- and/or beta-blockers, debulking surgery is the first treatment step. In case of a sufficient uptake of (123)I-MIBG treatment with targeted radiation therapy, use of (131)I-MIBG is an option as an adjuvant therapy, following debulking surgery. Chemotherapy should be applied to patients without positive MIBG-scan, with no response to (131)I-MIBG or progression after radionuclide treatment, and especially in cases with high proliferation index. The most effective chemotherapy regimen appears to be the CVD-scheme, including cyclophosphamide, vincristine, and dacarbazine. The so-called targeted molecular therapies with treatment combinations of temozolomide and thalidomide, or sunitinib monotherapy, and novel therapeutic somatostatin analogues have shown promising results and should thus encourage clinical trials to improve the prognosis of metastatic PCC. Within this review the current treatment modalities and novel molecular strategies in the management of this disease are discussed and a treatment algorithm is suggested.
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Affiliation(s)
- R. Ajallé
- 1st Department of Medicine, University of Lü beck, Lü beck, Germany
| | - P. F. Plouin
- Hypertension Unit, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
| | - K. Pacak
- Endocrinology Branch, NICHD, NIH, Bethesda, MD, USA
| | - H. Lehnert
- 1st Department of Medicine, University of Lü beck, Lü beck, Germany
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Nomura K, Kimura H, Shimizu S, Kodama H, Okamoto T, Obara T, Takano K. Survival of patients with metastatic malignant pheochromocytoma and efficacy of combined cyclophosphamide, vincristine, and dacarbazine chemotherapy. J Clin Endocrinol Metab 2009; 94:2850-6. [PMID: 19470630 DOI: 10.1210/jc.2008-2697] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT About 10% of pheochromocytomas are malignant. Exact survival has not been reported, nor has an analysis of the efficacy of chemotherapy on survival time. OBJECTIVE The aim of this study was to analyze the survival curves and survival times of patients with malignant pheochromocytoma and to determine the efficacy of chemotherapy on prolongation of life. DESIGN An inception cohort and Kaplan-Meier survival analysis was conducted. PATIENTS AND OUTCOME MEASURES Thirty-two patients with metastasized malignant pheochromocytoma were analyzed for survival. Twenty-five patients had undergone excision of their primary tumors. Survival curves were compared among the 16 patients in this group treated with combined chemotherapy using cyclophosphamide, vincristine and dacarbazine (CVD) and the nine patients not treated with chemotherapy. RESULTS The survival curve of the 32 patients declined continuously and linearly to at least 20 yr after the diagnosis of pheochromocytoma. The 50% survival rate was estimated to be 14.7 yr. In the 25 patients whose primary tumor was excised, patients who already had metastases at the time of pheochromocytoma diagnosis had better survival than those whose metastases were found later. The survival rate after diagnosis of metastasis was worse in the CVD group than in controls. When the effects of CVD were examined after stratifying several factors, female gender and adrenal origin of tumor were found to be negative prognostic factors for CVD chemotherapy. CONCLUSION The present study revealed a long survival time. CVD chemotherapy was not shown to extend survival, especially for women and patients with adrenal gland-derived primary tumors.
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Affiliation(s)
- Kaoru Nomura
- Department of General Medicine, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjyuku-ku, Tokyo, Japan.
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Sakamaki Y, Yasukawa M, Kido T. Pheochromocytoma of the posterior mediastinum undiagnosed until the onset of intraoperative hypertension. Gen Thorac Cardiovasc Surg 2008; 56:509-11. [PMID: 18854928 DOI: 10.1007/s11748-008-0282-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 05/20/2008] [Indexed: 12/01/2022]
Abstract
An asymptomatic 42-year-old man was diagnosed with a posterior mediastinal mass, most likely a nonfunctioning, benign, neurogenic tumor for which thoracoscopic surgery was initially indicated. However, the systemic blood pressure rapidly increased to a critical level immediately after starting the surgical manipulation of the tumor, which was suggestive of a hyperfunctioning pheochromocytoma. The tumor was removed after controlling the blood pressure and was histologically diagnosed as a pheochromocytoma. The patient had an uneventful course, and the tumor was proven to be sporadic through further postoperative investigations. The possibility of extraadrenal pheochromocytoma should be considered in the preoperative diagnosis of an intrathoracic paraaortic tumor, even in an asymptomatic patient.
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Affiliation(s)
- Yasushi Sakamaki
- Department of Chest Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tennoji, Osaka, 543-8502, Japan.
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