Remote Recurrence Of Malignant Pheochromycytoma 14 Years After Primary Operation

Abstract

The reported incidence of recurrent pheochromocytoma is 4.6% to 6.5%.1 Recurrence of pheochromocytoma more than 10 years after initial treatment is rare. We present a case of recurrent pheochromocytoma with malignant change 14 years after primary surgery. CASE REPORT A 72-year-old female had undergone left total adrenalectomy 14 years previously for adrenal pheochromocytoma. She had initially presented with frequent episodes of faintness and abdominal pain during periods of emotional stress. It is noteworthy that there were no classic signs or symptoms of pheochromocytoma, such as headache, palpitation, diaphoresis or hypertension, at initial presentation. Postoperatively followup abdominal ultrasonograms had consistently been negative. At presentation the patient reported discomfort at the previous lumbar incision several months in duration. Biochemical analyses, including 24-hour urinary vanillylmandelic acid and metanephrines, were within normal limits. Abdominal ultrasonography revealed a circumscribed 3.6 cm. hypoechoic lesion in the left suprarenal region. Computerized tomography and magnetic resonance imaging further demonstrated the mass to be highly suspicious for pheochromocytoma, which was later confirmed on ultrasound guided biopsy (see figure). A marked transient increase in blood pressure was noted at exploration. Pathological findings confirmed the presence of recurrent pheochromocytoma with additional muscular invasion, which indicated malignant change. The patient subsequently received external beam radiation therapy started on postoperative day 7. DISCUSSION