Cystic pheochromocytoma: a rare variant of adrenal gland tumor case report

Abstract

Abstract Introduction/Objective Pheochromocytoma is the primary adrenal medullary tumor in adults. Patients usually present with sustained or sporadic hypertension. The tumors are almost always solid. Cystic pheochromocytoma (CP) is extremely rare with only a few cases reported in the literature. Patients with CP may be asymptomatic and normotensive and be diagnosed incidentally on imaging or intraoperatively. Methods/Case Report We report a case of an 82-year-old male with a large CP who presented with back pain. The patient was hypertensive preoperatively (140/85 mmHg). Imaging showed a 5.4 cm complex right adrenal mass that could not be further classified. Labs showed markedly increased 24hr urine normetanephrine (1342 ug/24hr). The patient was presumed to have a pheochromocytoma and was preoperatively treated with an alpha-blocker. At surgery an 8.0 cm multiloculated cystic adrenal mass was removed, and grossly the specimen consisted of a brown, multicystic mass filled with brown liquid. Histology revealed the septa to contain nests of polygonal cells with vacuolated to basophilic granular cytoplasm with moderate nuclear pleomorphism . Immunohistochemical staining was positive for synaptophysin, chromogranin and S-100, which confirmed the diagnosis of CP. Patient’s postoperative blood pressure was 130/60 mmHg. Results (if a Case Study enter NA) NA Conclusion Cystic pheochromocytoma has to be in the differential for a retroperitoneal cystic mass in order that clinicians, radiologists as well as pathologists undertake proper patient management and diagnosis.