Recurrence of non-cardiogenic pulmonary edema and sustained hypotension shock in cystic pheochromocytoma

Abstract

Pheochromocytoma is a rare neuroendocrine tumor which derives from chromaffin cells of the adrenal gland or relevant to sympathetic nerves and ganglia. The clinical features of pheochromocytoma are various. Paroxysmal episodes of serious hypertension, headache, palpitation, and diaphoresis are the typical manifestations (Bravo, 2004). Hypotension shock, pulmonary edema, and acute coronary syndrome induced by pheochromocytoma are uncommon (Malindretos et al., 2008; Batisse-Lignier et al., 2015). In this study, we present a rare case of cystic pheochromocytoma causing recurrent hypotension shock, non-cardiogenic pulmonary edema, and acute coronary syndrome, and the possible mechanisms are discussed.

Keywords: Pheochromocytoma; Non-cardiogenic pulmonary edema; Sustained hypotension; Acute coronary syndrome.

Fig. 1

Contrast-enhanced magnetic resonance imaging of upper abdomen Pheochromocytoma mass (arrows) in left gland: heterogeneous signal on T1 and T2 weighted images (a, b); hyperintense signal in solid area and non-enhancing cystic lesion in center on enhancement scan (c, d)

Fig. 2

Histopathology analysis of left adrenal gland (a) H & E staining (10×): nested arrangement of cells with granular basophilic cytoplasm and prominent nucleolus. (b–f) Immunohistochemical staining (10×): (b) CD56 (+); (c) CgA (+); (d) Syn (+); (e) S-100 (+); (f) Ki-67 (−), confirming the diagnosis of pheochromocytoma. H & E: hematoxylin and eosin; CgA: chromogranin A; Syn: synaptophysin