A missed diagnosis or a masquerading disease: back to the basics

Abstract

A 23-year-old gravid Ugandan female at 26 weeks was admitted to the maternity ward with sweats, abdominal pain, feeling of apprehension and palpitations. A diagnosis of pre-eclampsia was made and treatment with magnesium sulphate initiated. She was later transferred to intensive care unit for monitoring and control of blood pressure. Due to her labile blood pressures despite intravenous hydralazine and metoprolol, the pregnancy was terminated. However, she continued to have labile blood pressures. Better control of blood pressure was achieved on oral prazocin and nifedipine. The patient was then transferred to floor and discharged home a few days later. An abdominal computed-tomography scan showed a solid lobulated right paravertebral mass superio-medial to the right kidney. An open adrenelectomy was performed and antihypertensives discontinued. Histopathology revealed a benign pheochromocytoma. The mother had good post-operative outcome; however the premature baby died 2 days later in the special care unit.

Keywords: Pre-eclampsia; blood pressures; magnesium sulphate; pheochromocytoma.

Figure 1

Section of tissue block obtained from adrenal tumor with Hematoxylin and Eosin stain, under low power, showing organoid neoplasm with large nests of tumor cells (black arrows) surrounded by rim of spindle cells or sustentacular cells (yellow arrows). These are features suggestive of an adrenal pheochromocytoma

Figure 2

Immunohistochemistry of adrenal tumor showing diffuse cytoplasmic positivity of tumor cells to neuroendocrine markers namely Synaptophysin (black arrows) and Chromogranin (red arrows)