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. 2021 Aug:85:106248.
doi: 10.1016/j.ijscr.2021.106248. Epub 2021 Jul 27.

Retroperitoneal pheochromocytoma: Unsual presentation and atypical location

Carlos Eduardo Rey Chaves  1 , Daniela Ayala  2 , Gabriel García  2 , Danny Conde Monroy  3 , Juan Carlos Sabogal Olarte  4
Affiliations

Retroperitoneal pheochromocytoma: Unsual presentation and atypical location

Carlos Eduardo Rey Chaves et al. Int J Surg Case Rep. 2021 Aug.

Abstract

Introduction and importance: Pheochromocytomas are rare tumors (0.1-2% of incidence), arising from the chromaffin cells in the sympathoadrenal system. Approximately 85% of the times are localized in the adrenal medulla; therefore, could be placed extra adrenal in 15% of the population. 10-30% of the cases could be asymptomatic. Classic symptoms vary from palpitations, tachycardia, hypertension.

Case presentation: Case report of a 37-year-old female patient presented with diffuse abdominal pain, with any associated symptoms. Contrast computed tomography was performed; a retroperitoneal mass was found, contacting the third portion of the duodenum. Intraoperative hypertensive crisis was documented with the manipulation of the mass. Octreotide infusion was administered with the normalization of the clinical condition. Patients do not present any postoperative morbidity after 90 days. Pathology reports chromaffin cells concluding pheochromocytoma.

Discussion: Pheochromocytomas are rare tumors with an annual incidence between 3 and 8 cases per million population per year in some series of cases. In general terms prevalence rounds 0.1-0.6% of patients with hypertension. Surgical management is the definitive treatment for pheochromocytoma benign or malign. Morbidity described in literature reaches 40% with 20% of mortality in some series of cases. In our patient we do not present postoperative complications.

Conclusion: Intraoperative hypertension is a clinical and surgical challenge, not only for the surgeon, also anesthesiology. Pheochromocytoma it's a complex entity and could be silent in until 30% of the cases, should be suspected in all neuroendocrine retroperitoneal tumors. Multidisciplinary approach with anesthesia, endocrinology and surgery department is mandatory to have good postoperative outcomes.

Keywords: Chromogranin A; Hypertension; Pheochromocytoma; Surgery.

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Conflict of interest statement

Authors do not declare any conflicts of interest.

Figures

Image 1
Image 1
A. Coronal view in abdomen CT (*tumoral mass)/B. Sagital view in abdomen CT (*tumoral mass).
Image 2
Image 2
A. Sagital view in MRI (*tumoral mass). B. Coronal view in MRI (*tumoral mass).
Image 3
Image 3
Tumor exposition and vascular ligation.
Image 4
Image 4
Surgical piece.
See this image and copyright information in PMC

References

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