Undiagnosed giant cystic pheochromocytoma: A case report

Abstract

Giant cystic pheochromocytomas (GPCCs) are rare adrenal tumors and the majority of them present as asymptomatic. As a result GPCCs often remain undiagnosed until surgery and therefore the surgical team face a greater challenge in perioperative management. The present study describes the case of a 36 year-old woman with an undiagnosed GPCC, which was successfully resected despite the occurrence of perioperative cardiovascular events, including hypertension, hypotension, ventricular arrhythmias, acute heart failure, acute myocardial infarction, and the patient was discharged home without any recurrence. It should be considered in retroperitoneal tumour of patients with nonspecific symptoms and given adequate treatment to promote the perioperative safety.

Keywords: hypertension crisis; pheochromocytoma; renal tumor.

Figure 1.

Contrast-enhanced computed tomography scan of the abdomen demonstrates an 11 cm cystic-solid mass associated with the left kidney.

Figure 2.

Typical histopathological pictures of tumor within adrenal gland. (A) The tumor has a thick fibrotic capsule without capsular invasion (hematoxylin-eosin, 10×10). (B) The neoplastic cells are characteristically arranged in well-defined nests (‘Zellballen’) bound by a delicate fibrovascular stroma. The cells have a finely granular cytoplasm. The nuclei are usually round or oval with prominent nucleoli. (C) Cells stained brown are positive for chromogranin A. (D) Cells stained brown are positive for synaptophysin (hematoxylin-eosin staining; magnification, x100).