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Case Reports
. 2019 Jan-Mar;65(1):44-46.
doi: 10.4103/jpgm.JPGM_701_17.

Synchronous renal cell carcinoma and pheochromocytoma presenting as acute decompensated heart failure

H H Chen  1 , S T Wu  2 , Y C Lin  3 , C S Lin  4
Affiliations
Case Reports

Synchronous renal cell carcinoma and pheochromocytoma presenting as acute decompensated heart failure

H H Chen et al. J Postgrad Med. 2019 Jan-Mar.

Abstract

We report a 49-year-old woman who presented with a hypertensive crisis and acute heart failure and reduced left ventricular systolic function. An abdominal ultrasonography revealed a huge lobulated heterogeneous mass at the lower pole of the right kidney and a mass over the left suprarenal area, which were further delineated by magnetic resonance imaging. The patient underwent laparoscopic right radical nephrectomy and left adrenalectomy. Histopathological analysis confirmed the diagnoses of clear cell renal cell carcinoma of the right kidney with metastasis to the lung; and atypical pheochromocytoma of the left adrenal gland. Target therapy was initiated, which resulted in stabilization of the patient's tumors and the recovery of her heart function. To avoid a delayed diagnosis and catastrophic outcome, clinicians should consider such rare causes of acute decompensated heart failure.

Keywords: Heart failure; hypertensive crisis; pheochromocytoma; renal cell carcinoma.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) A chest X-ray conducted in the emergency department revealed cardiomegaly and patchy airspace consolidations with infiltrations in the right lung field. (b) One year later, another chest X-ray revealed normal heart size without visible airspace consolidations
Figure 2
Figure 2
Magnetic resonance imaging with contrast demonstrated lobulated masses over lower pole of the right kidney (arrow) and left suprarenal area (arrow)
Figure 3
Figure 3
The gross pictures of right renal mass (a) and left adrenal mass (b). (c) The right renal mass showed compact tumor cells with clear cytoplasm and thin-walled vasculature that were immunoreactive for epithelial membrane antigen (EMA), CD10, and vimentin (×50), indicating clear cell renal cell carcinoma (H and E, ×100). (d) The left adrenal mass showed trabecular or solid patterns of polygonal shaped cells with vacuolated cytoplasm that were immunoreactive for S100 and chromogranin-A (×50), indicating pheochromocytoma (H and E, ×100)
See this image and copyright information in PMC

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