Giant malignant phaeochromocytoma

Giant cystic pheochromocytoma located in the renal hilus

A malignant tumor in the past medical history of a patient often makes the differential diagnosis of a second tumor more difficult, especially if one of the tumors does not show its characteristic features. The authors report a case of a 55-year-old male who presented with a malignant melanoma on his left shoulder. A retroperitoneal giant cystic mass, 200 mm in diameter, was found incidentally. Adrenal origin was ruled out by imaging techniques. The absence of typical clinical symptoms made a correct preoperative diagnosis unlikely, and severe cardiovascular complications set in during surgery. Considering the characteristics of the cutaneous malignant melanoma, the metastatic origin of the giant retroperitoneal tumor was not likely either. During surgery the left kidney, with a cystic tumor located in the hilus, was removed. The postoperative pathologic diagnosis was pheochromocytoma located in the hilus of the left kidney.

A painful pulsatile abdominal mass in a young man with elevated blood pressures: an unusual presentation of phaeochromocytoma

We report an unusual presentation of phaeochromocytoma in a young man with a painful, pulsatile abdominal mass and elevated blood pressures. This led to a delay in diagnosis and resulted in the administration of triggers of catecholamine release, possibly causing a catecholamine surge. This caused the development of catecholamine-induced cardiomyopathy and multiple organ failure, requiring inotropic and ventilatory support, intra-aortic balloon pump and dialysis. Fortunately, his condition reversed with supportive treatment and alpha-adrenergic blockade. This illustrates the importance of having a high index of suspicion of phaeochromocytoma, especially in young patients with elevated blood pressures.

Giant phaeochromocytoma: case report

A case of giant phaeochromocytoma occurring in a 47-year-old man with no signs or symptoms of catecholamine secretion is reported. Abdominal ultrasound scanning, chest X-ray, computed tomography and magnetic resonance imaging were preoperatively performed. The patient was operated through a thoracoabdominal incision and section of the left hemidiaphragm. The giant retroperitoneal mass was en-bloc resected together with the left adrenal gland. Macroscopic sectioning showed a smoothly rounded 29 x 21 x 12 cm tumour attached to a normal left adrenal gland, weighing 4050 gr. The huge size of the neoplasm, the several areas of necrosis, the size and monomorphic appearance of the cells, and the large number of mitotic figures afforded a diagnosis of malignant phaeochromocytoma.