MALIGNANT PHEOCHROMOCYTOMA: CASE REPORT OF SURGICAL TREATMENT

Goals: Describe successful surgical treatment of malignant pheochromocytoma, in a young pacient with difficult management of hypertension. Introduction: Pheochromocytoma is a rare chromaffin cell tumor, cathecolamine producer, which can cause high blood pressure and the three symptons: sudden headache, palpitations and sweating. The diagnosis is suggestive when find increased urinary metanephrine and normetanephrine values, as well as imaging indicating tumor location. The treatment is based on tumor and adrenal gland resection. Pacient, S.A.P, female, 21 years old, white, married, teacher. In the last 6 months, pacient with high blood pressure, even in use of antihypertensive drugs. Presenting also, palpitation, headaches, nausea, sweating, fatigue and weight loss. She performed the following exams: Abdome Ultrasound that identified an oval, hypogenous, and with reduced vascularization mass on the topography of the left adrenal gland, measuring 5,8×5,8×4,5 cm; Abdominal Computed Tomography identifying a solid expansive lesion in the left adrenal gland, with oval shape and circumscribed contours, measuring 7.8×5.6cm, and with hyper vascular enhancement after iodinated contrast infusion, as well as tortuous and ectatic peripheral vessels to the lesion, in addition, there was another solid retroperitoneal expansive lesion to the left aortic, caudal to suprascribed adrenal lesion, with oval shape and circumscribed contours, with hyper vascular enhancement measuring 4.0×3.4cm, showing hypodense central component suggesting necrosis / liquefaction (as a diagnosis , interrogated pheochromocytoma and supra adrenal paraganglioma); laboratory tests: urinary metanephrines 15981 / 24h (RV 104-718), renin 498.2 (RV 2.8-39.9) and dehydroepiandrosterone sulfate 93 (RV 10-75). It was choosen for a surgical treatment, tumor adrenal gland resection the surgery was made without any complications. The pathologist concluded metastatic pheochromocytoma, with necrosis present and presence of hyaline globules. Patient with good postoperative evolution, remaining normotensive and without new paroxysms, even without antihypertensive medications. Conclusion: It was able to conclude that the malignant pheochromocytoma, besides being rare, have the diagnostic facilitated by the patients clinic, and if approached early, has effective surgical treatment.

 

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Publication History

Article published online:
23 October 2019