Renal Cell Carcinoma and Ipsilateral Pheochromocytoma With Neoplasm-to-Neoplasm Metastasis

Abstract

A total of 13 cases of pheochromocytoma associated with renal cell carcinoma has been reported previously,l including 1 in which renal cell carcinoma was metastatic to ipsilateral pheochromocytoma.2 We report the fourteenth case of pheochromocytoma associated with renal cell carcinoma and the second in which renal cell carcinoma was metastatic to pheochromocytoma. CASE REPORT A 43-year-old man with a 2-year history of headache and high blood pressure was hospitalized with symptoms of pheochromocytoma. He also reported sweating and palpitation episodes. Physical examination showed an enlarged thyroid gland. Urinary vanillylmandelic acid and metanephrine were increased. Radiological evaluation revealed bilateral suprarenal masses (2 x 3 x 4 and 4 x 4 X 3 cm. on the right and left sides, respectively) as well as a 7 cm. lesion on the anterolateral right kidney. Thyroid scan showed a multinodular goitre with hypoactive areas but thyroid function tests were normal. Fine needle aspiration biopsy revealed atypical cells. Using a bilateral subcostal incision exploration was performed, which was compatible with the radiological evaluation. Right nephrectomy with para-aortic lymph node dissection and bilateral adrenalectomy were done. Pathological examination revealed renal cell carcinoma in the right kidney, pheochromocytoma in the right suprarenal gland, and renal cell carcinoma metastasis to the pheochromocytoma in the right and to the left suprarenal glands (see figure). Convalescence was uneventful and blood pressure returned to normal. A total of 11 courses of adjuvant chemotherapy with prednisolone, vinblastine and medmxyprogesterone acetate was given weekly until it was withheld due to neutropenia. Two