Extra-adrenal Pheochromocytoma Research Articles

MON-910 I’m Not Crazy! I Get a Headache When I Pee: A Case of Metastatic Bladder Paraganglioma

Tumors of chromaffin cells derived from the embryonic neural crest are classified as pheochromocytomas when located in the medulla of the adrenal glands and paragangliomas when located externally to it. Bladder paragangliomas constitute less than 1% of all catecholamine-secreting neuroendocrine tumors. Usually, these tumors are functional and symptomatic, but in other cases, they can be silent. We present an interesting case of a patient with post-micturition catecholaminergic crises that went undiagnosed for several years until found to have a bladder paraganglioma.A 60-year-old male with a past medical history of TIA, HTN, CAD, and ischemic cardiomyopathy presented with post-micturition headaches since age 14. Despite work up, no etiology was found. Eventually, the patient was referred to mental health for what was thought to be somatic symptoms. In 2010, he was diagnosed with hypertension and started keeping daily blood pressure (BP) logs, which showed BP fluctuation as high as 260s/110s with high-volume micturition, yet normotensive at other times. This led to imaging and cystoscopy which revealed a 6-cm bladder lesion. Surgical resection was completed, and pathology showed paraganglioma with positive margins and lymphovascular invasion. He was lost to follow up until 2017 when he presented with hypertensive crisis. CT and octreotide scan showed numerous osseous lytic lesions concerning for metastases. Laboratory testing confirmed excess catecholamines. He was referred to oncology, and after consideration of several treatment options, the patient was started on Xgeva and Sandostatin LAR. However, he passed away shortly thereafter.Bladder paragangliomas are very rare and account for 6% of extra-adrenal pheochromocytomas. They occur more frequently in women than in men and clinically present mainly during the third decade of life. The patient typically suffers from hypertensive crises that may be accompanied by headache, palpitations, hot flushes, and sweating. These crises are mainly provoked by micturition, overdistention of the bladder, defecation, sexual activity, ejaculation, or bladder instrumentation. If there is high suspicion, biochemical and functional imaging workup should be performed. Surgery is the mainstay of the treatment and requires total excision. If diagnosed preoperatively, a partial cystectomy is preferred over trans-urethral resection as the majority of these tumors extend in the deep layers of the detrusor muscle. Because they are likely to recur and to metastasize, annual follow up with a measurement of plasma and urinary catecholamine levels and cystoscopy are essential. A functional imaging study (Ga-DOTATE scan) should be done to locate recurrence if symptoms reappear or catecholamine resurgence occurs.

Paraganglioma of the urinary bladder

Paragangliomas are extra-adrenal pheochromocytomas. They are catecholamine-secreting neoplasms developing from the chromaffin cells derived from the ectodermic neural system. They are rare neoplasms that account for less than 0.06% of all urinary bladder tumors and 6% of all extra-adrenal pheochromocytomas. They arise from chromaffin tissue of the sympathetic nervous system within the layers of the bladder wall. They can be present in any part of the bladder with a predilection for the detrusor muscle with the most common sites being the dome and trigone.They may be nonfunctional or functional. The most common symptoms are hypertension and hematuria. Functional tumors usually present with symptoms of excessive catecholamine secretion. The patient typically suffers from hypertensive crises that may be accompanied by headache, palpitations, hot flushes, and sweating. Postmicturition hypotension and syncope are another common presentations. They share a genetic basis and can be related to a number of hereditary conditions.They are usually benign but there are no reliable morphologic criteria by which to separate the benign from the malignant forms. Here we present a 22 years old female with hematuria which on histopathology proved to be paraganglioma of the urinary bladder.

Successful Pregnancy Outcomes After Laparoscopic Management of Pheochromocytoma.

Background: Pheochromocytoma is a rare cause of hypertension in pregnancy, which is often overlooked; especially in late pregnancy because of more prevalent pre-eclampsia. It has been associated with significant morbidity and mortality rates in both mother and fetus, if not diagnosed and treated in time. Minimally invasive surgery has been infrequently used for surgical management of pheochromocytoma in pregnancy, with <20 reported cases in English literature. Case Presentation: A 26-year-old pregnant woman presented at 9 weeks of gestation with complaints of palpitations, sweating, and headache; with past history of first trimester spontaneous abortion caused by accelerated hypertension. She was found to have hypertension and diabetes, but no pedal edema, weight gain, or proteinuria. Ultrasonogram and MRI of abdomen revealed a left adrenal mass and 24 hours urinary catecholamines levels were increased, suggesting a pheochromocytoma. After preoperative optimization in consultations with obstetricians, endocrinologists, and anesthetists, she underwent laparoscopic left adrenalectomy during 15th week of gestation. Perioperative hospital course was uneventful for both mother and the fetus. After adrenalectomy, her diabetes was cured and hypertension was controlled with single antihypertensive. She was readmitted at 31 weeks of gestation with accelerated hypertension and underwent emergency caesarean for impending eclampsia at 32 weeks, and delivered a healthy female baby. 131I-meta-iodobenzylguanidine (MIBG) scan and 68Ga-[1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI(3)-octreotide positron emission tomography-CT (68Ga-DOTANOC PET-CT) scan was obtained in postpartum period to rule out any extra-adrenal pheochromocytoma, both of which did not reveal any abnormality. At 1 year follow-up, she is normoglycemic and hypertension controlled on single antihypertensive. Conclusion: Pheochromocytoma in pregnancy is a rare but potentially lethal condition, and high index of suspicion is required for early diagnosis. Multidisciplinary coordination is required for effective management of this rare condition. Laparoscopic adrenalectomy is safe in second trimester of pregnancy for both mother and fetus.

Diagnóstico intraoperatório de paraganglioma retroperitoneal em massa abdominal

Modelo do estudo: relato de caso; Importância do Problema: O presente relato de caso tem como objetivo relatar o caso de paciente do sexo masculino, 40 anos, com quadro de dor em região lombar esquerda há seis meses, sem massas palpáveis e sem achados de massas retroperitoneais à Ultrassonografia de abdome. A investigação diagnóstica constatou, através de Tomografia Computadorizada de abdome, imagem de lesão retroperitoneal acoplada medialmente à artéria aorta, com suposto diagnóstico de Sarcoma Retroperitoneal e, por conseguinte, indicação de tratamento cirúrgico. Durante o período intraoperatório, o paciente apresentou sintomas adrenérgicos, que cessaram após a ressecção completa da lesão e ligadura de parte das aderências do tumor ao retroperitônio. A biópsia evidenciou se tratar de um Paraganglioma Retroperitoneal. A partir do estudo de caso supracitado, é possível perceber a importância de incluir o Paraganglioma como diagnóstico diferencial de tumores retroperitoneais, em consequência de sua raridade, difícil diagnóstico e importância clínica. Comentários: Os Paragangliomas, frequentemente chamados de feocromocitomas extra-adrenais, são tumores raros, na sua maioria benignos, produtores de catecolaminas, com origem em células provenientes do Sistema Nervoso Autônomo e das células da crista neural.1 A sintomatologia clássica desses tumores, em função da capacidade secretora, inclui palpitações, cefaleias e diaforese, associados a Hipertensão Arterial (HTA).

Paraganglioma vulvovaginal primario. Reporte de caso

El paraganglioma es una neoplasia neuroendocrina extraadrenal derivada de precursores de la cresta neural, que surgen en asociación con los ganglios autónomos y, en ocasiones, también son denominados feocromocitomas extraadrenales. Se definen por su sitio anatómico y si son o no hormonalmente funcionales. Los paragangliomas son neoplasias poco frecuentes del tracto genital femenino y pueden aparecer en ovarios, útero o cuello uterino. Los que aparecen en la región vulvovaginal son extremadamente raros. Las manifestaciones clínicas dependen de la secreción no regulada de catecolaminas y la localización. El diagnóstico se basa en hallazgos morfológicos e inmunohistoquímicos. La resección quirúrgica es un tratamiento primario para este tumor, ya que no responde bien a la quimio-radioterapia. Debido a su baja frecuencia y sintomatología inespecífica, puede mostrar dificultades para realizar el diagnóstico. Se presenta un caso de paraganglioma vulvovaginal primario.

Renal Infarction Associated With Extra-Adrenal Pheochromocytoma

Pheochromocytomas have been described to be associated with renal infarction in a few sporadic cases. The underlying pathophysiologic mechanisms are catecholamine-induced vasospasm and direct compression or invasion of the tumor on renal artery or its branches. However, renal infarction caused by extra-adrenal pheochromocytoma is rarely reported. We describe an unusual case of benign extra-adrenal pheochromocytoma complicated with left renal infarction by severe vasospasm.

Laparoscopic Resection of Subclinical Functioning Para-aortic Paraganglioma

Introduction: Extra-adrenal pheochromocytomas (paragangliomas) are neuroendocrine tumors derived from extra-adrenal chromaffin cells. Although laparoscopic resection of adrenal pheochromocytomas is a common procedure, there are few reports of the use of this approach in extra-adrenal para-aortic paragangliomas. Here, we report the case of a patient with a subclinical functioning para-aortic paraganglioma that was successfully resected laparoscopically. Case presentation: A 58-year-old man was referred to our department for treatment of a para-aortic tumor after endoscopic submucosal dissection of early-stage colorectal cancer. Positron emission tomography-computed tomography showed abnormal accumulation by the para-aortic tumor. During its laparoscopic resection, the patient's blood pressure unexpectedly rose to over 180 mmHg, which suggested that the tumor was a paraganglioma. The diagnosis was confirmed by immunohistochemical staining, which showed chromogranin-positive cells forming a Zellballen pattern. The operation was successfully completed, and the patient's postoperative course was uneventful. Conclusion: Laparoscopic resection may be a suitable procedure for the treatment of retroperitoneal paraganglioma.

Pheochromocytoma

Objective: Pheochromocytomas are catecholamine-producing neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. There is no large-scale study in Taiwan at present. Our retrospective analysis was focused on clinical characteristics of Taiwanese patients with pheochromocytoma. Method: We retrospectively reviewed 48 patients who were pathologically proved as pheochromocytoma at the Kaohsiung Veterans General Hospital between Jan. 1990 and Jan. 2014. Parameters including patient and tumor characteristics, clinical presentation, treatment and long-term followup results were collected from the medical records. Metastasis was confirmed by pathologic proof using surgical removal or percutaneous biopsy. Result: Thirty-one patients (64.5%) had adrenal and 17 (35.4%) had extra-adrenal pheochromocytoma. The locations of extra-adrenal pheochromocytoma included the retroperitoneum in 6 patients (35%), head and neck in 4 (23%), scrotum in 2 (12%), urinary bladder in 2 patients (12%), multiple organs in 2 (12%), and mediastinum in 1 (6%). The most common symptom was sustained hypertension (52%). Five patients were diagnosed as malignant pheochromocytoma due to pathologically proved metastasis. Conclusion: Pheochromocytomas are rare neuro-endocrine tumors with a highly variable clinical presentation. Prompt surgical removal of pheochromocytoma ensures a better prognosis. Radical surgical removal of tumor with vigorous control of blood pressure is the mainstay to improve symptoms and survival for malignant pheochromocytoma. Multi-center and large-scale studies were warranted and Lifelong followup is strongly recommended for all patients with pheochromocytoma.

Clinical Syndromes and Genetic Screening Strategies of Pheochromocytoma and Paraganglioma.

Pheochromocytomas (PCCs) are rare neuroendocrine tumors that originate from chromaffin cells of the adrenal medulla, and paragangliomas (PGLs) are extra-adrenal pheochromocytomas. These can be mainly found in clinical syndromes including multiple endocrine neoplasia (MEN), von Hippel–Lindau (VHL) syndrome, neurofibromatosis-1 (NF-1) and familial paraganglioma (FPGL). PCCs and PGLs are thought to have the highest degree of heritability among human tumors, and it has been estimated that 60% of the patients have genetic abnormalities. This review provides an overview of the clinical syndrome and the genetic screening strategies of PCCs and PGLs. Comprehensive screening principles and strategies, along with specific screening based on clinical symptoms, biochemical tests and immunohistochemistry, are discussed.

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection.

To determine the incidence and preoperative risk factors of post-excisional hypoglycemia in patients undergoing pheochromocytoma resection. Patients who underwent surgical resection of pheochromocytoma at a single institution were retrospectively enrolled in the present study. The primary end-point was the development of post-excisional hypoglycemia; that is, a serum glucose level <70mg/dL. The serum levels of immunoreactive insulin and glucose levels during the preoperative oral glucose-tolerance test and surgery were analyzed to elucidate the mechanism of hypoglycemia. A total of 49 patients underwent surgical resection of pheochromocytoma, of which 21 patients (43%) developed post-excisional hypoglycemia. The incidence of hypoglycemia was not statistically different between patients with adrenal tumors and those with extra-adrenal tumors (18/41 [44%] vs 3/8 [38%], respectively, P=0.73). There was no difference in the immunoreactive insulin/glucose ratio during the preoperative oral glucose-tolerance test between patients with and those without post-excisional hypoglycemia. The intraoperative immunoreactive insulin/glucose ratio was significantly higher in patients with hypoglycemia than in those without hypoglycemia. A higher 24-h urinary epinephrine level, but not norepinephrine level, was a predictive factor for post-excisional hypoglycemia. Post-excisional hypoglycemia is a frequent complication of pheochromocytoma resection, irrespective of the tumor location, and might be common in patients with epinephrine-predominant tumors. All patients undergoing resection of adrenal and extra-adrenal pheochromocytoma require intensive monitoring of serum glucose levels during and after surgery.

68Ga-DOTATOC PET/CT in the localization of metastatic extra-adrenal paraganglioma and pheochromocytoma compared with 18F-DOPA PET/CT

Purpose18F-Fluoro-l-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant extra-adrenal paraganglioma (PGL) and pheochromocytoma (PHEO) but lower sensitivity in metastatic disease. These tumours are of neuroendocrine origin and can be detected by 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) PET. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA as radiolabels for PET/CT imaging for the diagnosis of metastatic extra-adrenal PGL and PHEO. Combined cross-sectional imaging was the reference standard. MethodsA total of 6 men and 4 women (age range 22–72 years) with anatomical and/or histologically proven metastatic PGL and PHEO were included in this study. Of these patients, 2 male patients suffered from PHEO, while the remaining 8 patients were diagnosed as metastatic extra-adrenal PGL disease. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC and 18F-DOPA PET. The imaging results were analyzed on a per-lesion basis. The maximum standardized uptake value (SUVmax) of each functional imaging modality in concordant tumour lesions was measured. ResultsCompared with anatomical imaging, the per-lesion detection rate of 68Ga-DOTA-TOC was 100% (McNemar, P<0.01), and that of 18F-DOPA PET was 82.3% (McNemar, P<0.8) in metastatic extra-adrenal PGL and PHEO. Overall, 68Ga-DOTA-TOC PET identified 67 lesions; anatomical imaging identified 62 lesions, and 18F-DOPA PET identified 56 lesions. The SUVmax (mean±SD) of all concordant lesions was 29.3±19.9 for 68Ga-DOTA-TOC PET and 12.3±9.1 for 18F-DOPA PET (Mann–Whitney U test, P<0.0001). Conclusion68Ga-DOTA-TOC PET offers the highest detection rate in metastatic extra-adrenal PGL and PHEO compared to 18F-DOPA PET and even to diagnostic CT, particularly in bone lesions. Combined functional/anatomical imaging (68Ga-DOTA-TOC PET/CT) enables exact tumour extension to be detected in these rare tumour entities, especially in the case of unclear anatomical correlation.

72] Phaeochromocytoma of the bladder: Report of a case and review of the literature

ObjectiveTo report on a case of phaeochromocytoma of the bladder and discuss general management principles of bladder phaeochromocytoma and the importance of long-term follow-up. Phaeochromocytomas are chromaffin cell tumours that are derived from neuroectodermal tissue of the adrenal gland and sympathetic paraganglia. These tumours can arise anywhere in the body from the skull (glomus and carotid bodies) to the bladder and prostatic glands. Phaeochromocytomas of the urinary bladder are rare tumours, accounting for 1% of extra-adrenal phaeochromocytomas and 0.06% of bladder tumours.

Use of desflurane during anesthesia for resection of extra-adrenal pheochromocytoma: a case report

BackgroundAlthough various agents are used during anesthesia for surgical resection of pheochromocytoma, application of desflurane has rarely been reported. We report the use of desflurane in a case receiving resection of extra-adrenal pheochromocytoma.Case presentationA 51-year-old female was transferred to our hospital for sustained hypertension. A diagnosis of extra-adrenal pheochromocytoma was made based on increased plasma catecholamine levels and radiographic findings. Surgical resection was planned after controlling blood pressure. General anesthesia was induced with propofol and fentanyl, followed by maintenance with desflurane 4.3% and remifentanil 0.2–0.4 μg/kg/min. Blood pressure and heart rate were stable during induction, tracheal intubation, and tumor manipulation. Blood pressure abruptly decreased to 62/40 mmHg after removal of the tumor, which was treated with noradrenaline. The surgery was completed uneventfully and the postoperative course was also uneventful.ConclusionDesflurane was safely used in combination with remifentanil during anesthesia for resection of extra-adrenal pheochromocytoma.

A Rare Case Report of Extra-adrenal Pheochromocytoma with Normal Blood Pressure: Is that Possible?

Extra-adrenal pheochromocytoma is uncommon and usually secreting nor-epinephrine. We are presenting a possible case of extra-adrenal pheochromocytoma in a 68-year-old male who was admitted to Queens Hospital Center complaining of shortness of breath for two days. Physical examination was unremarkable except tachycardia. Ventilation/perfusion (V/Q) scan showed the intermediate probability for pulmonary thromboembolism. Computed tomography (CT) chest confirmed the presence of old embolism and showed the 1.1 cm nodule in the left upper lobe. He suddenly collapsed and went into cardio-respiratory failure and attempts to resuscitate were futile. Results for pheochromocytoma workup received after the patient has passed away and it showed elevated levels of 24-hour urine metanephrine, normetanephrine, and Vanillylmandelic acid (VMA). In our patient, CT abdomen did not identify any mass in the adrenal gland or at the bifurcation of the aorta. The extra-adrenal tumor can secrete enough epinephrine to negate the hypertensive effect of norepinephrine. The clinician should be aware of the possibility that tachycardia could be a presenting symptom in pheochromocytoma although the patient is normotensive.

Pheochromocytoma and paraganglioma in Fontan patients: Common more than expected.

Pheochromocytoma and paraganglioma (extra-adrenal pheochromocytoma) are rare neuroendocrine tumors that arise from the neuroendocrine cells. Chronic hypoxia is known as a possible cause, and a strong link between cyanotic congenital heart disease and these tumors has been reported. However, reports of phechromocytoma/paraganglioma in Fontan patients were scarce. We herein report seven cases of phechromocytoma/paraganglioma after Fontan operation at a single tertiary center. We retrospectively reviewed medical records and imaging studies who diagnosed as phechromocytoma/paraganglioma after Fontan operation in Seoul National University Children's Hospital. Seven patients were identified during follow-up after Fontan operation, and the prevalence was 2.5% among Fontan patients greater than 10 years old on active follow-up. Three patients were diagnosed as phechromocytoma and 4 patients as paraganglioma. Median time interval between Fontan operation and diagnosis of pheochromocytoma/paraganglioma was 21.4 years (range, 10.4-29.7 years). Resting percutaneous oxygen saturation varied from 77% to 94%. All patients underwent complete tumor resection. Phechromocytoma recurred in two patients, of whom one patient died at the age of 18 years due to the tumor progression with multiple metastasis and aggravation of heart failure with profound cyanosis. Pheochromocytoma/paraganglioma developed after hepatocellular carcinoma in two patients. Phechromocytoma/paraganglioma could occur in Fontan patients more than expected. Because it is curable by tumor resection during its early phase, early diagnosis and treatment of pheochromocytoma are crucial in Fontan patients not to make hemodynamic deterioration and aggravation of heart failure.

Partial Cystectomy of Paraganglioma of the Urinary Bladder Before Living Kidney Transplantation: Case Report

BackgroundParaganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder paraganglioma before kidney transplantation is unknown. We report a case of partial cystectomy for urinary bladder paraganglioma before living kidney transplantation. Case PresentationA 59-year-old man with a 27-year history of hemodialysis was referred to our department for further examination of a bladder tumor detected during pre-transplantation testing. Cystoscopy revealed a submucosal tumor on the right side of the bladder. The patient experienced a hypertensive crisis during transurethral resection of the bladder tumor. Endocrinologic and pathologic examinations confirmed the diagnosis of paraganglioma in the urinary bladder. A partial cystectomy was performed before kidney transplantation. Nine months after partial cystectomy, the patient underwent AB0-incompatible living kidney transplantation from his spouse. No disease recurrence or graft rejection was observed 12 months after the transplantation. ConclusionsTo our knowledge, this is the 1st report on the management of paraganglioma in the urinary bladder before living kidney transplantation. Kidney transplantation after partial cystectomy is an option that may be considered in patients with paraganglioma of the urinary bladder, with careful observations of bladder function and vesicoureteral reflux to the grafts.

Paraganglioma of the urinary bladder

Paragangliomas are rare tumors, of neuroendocrine origin. These neoplasms are equivalent to extra-adrenal pheochromocytomas and their symptoms attributed to the secretion of catecholamines. When the urinary system is affected, the urinary bladder is implicated in the majority of the cases with the most specific symptom to be the hypertensive crisis during urination. Paragangliomas are considered benign, although in a small proportion of cases they may demonstrate aggressive biologic behavior. No distinct factors exist which distinguish these two groups; therefore, the follow-up of the patients with this rare tumor has to be close and long-term.

Factors influencing unplanned re-operation of pheochromocytoma and its prevention countermeasures

Objective To analyze the main causes for unplanned re-operation of pheochromocytoma(PCC) and explore the countermeasures on reducing the re-operation rate. Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in our hospital. There were 4 males and 2 females with a mean age of 46 years, ranged from 24 to 60 years. Only 1 patient had paroxysmal hypertension and headache, and the other 5 patients had no symptoms or atypical symptoms. Tumors of 3 cases were located in adrenal, and 3 were extra-adrenal PCCs. The average size of tumors was 5.25cm, ranged from 3 to 10 cm. Among the 6 cases, 2 cases were diagnosed as PCC preoperatively and underwent adequate preparationwith stable hemodynamics during the first operation, who encountered post-operative bleeding soon after the surgery. Four cases were misdiagnosed, with poor preoperative preparation and operation was aborted. One case was misdiagnosed as bladder carcinoma and underwent transurethral resection. Results All 6 re-operations were performed by urologists. The main causes for unplanned re-operation were as follows: perioperative hemodynamic unstability(50%, 3/6), post-operative bleeding(33.3%, 2/6), uncertainty of surgical outcome(16.7%, 1/6). Conclusions A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery. An appropriate surgical approach and a complete surgical hemostasis could help lowering the re-operation rate. Key words: Pheochromocytoma; Unplanned reoperation; Misdiagnosis; Pre-operative preparation

Diagnostic Imaging of Pregnant Women - The Role of Magnetic Resonance Imaging.

SummaryBackgroundPresentation of magnetic resonance imaging (MRI) findings in pregnant women in the Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland.Material/MethodsForty-three symptomatic pregnant women underwent MRI between 9 and 33 weeks of gestation (mean of 23 weeks). Moreover, we included 2 pregnant women who underwent fetal MRI and had incidental abnormalities.ResultsIn 9 cases, we excluded the suspected brain abnormalities. In 4 cases, we found unremarkable changes in the brain without clinical significance. One patient was diagnosed with multiple sclerosis, one with cortical dysplasia, one with pineal hemorrhage and one with a brain tumor. On abdominal MRI, 2 patients had normal findings, one patient had colon cancer with a hepatic metastasis, one patient had a hepatic angioma, one patient had an extraadrenal pheochromocytoma, one patient had an abscess in the iliopsoas muscle, 9 patients had myomas, two patients had ovarian simple cysts, two endometrial cysts, three dermoid cysts, one patient had sacrococcygeal teratoma, one patient had a cystadenofibroma (partial borderline tumor), one patient had an androgenic ovarian tumor and two patients had hyperreactio luteinalis. One patient was diagnosed with transient osteoporosis of the hip and one with a stress fracture of the sacral bone.ConclusionsMagnetic resonance imaging is the best imaging modality for pregnant women. Although ultrasonography is the method of choice, doubtful cases as well as structures that cannot be examined with ultrasonography can be non-invasively evaluated with MRI.

Is there any role for minimally invasive surgery in NET?

Neuroendocrine tumors (NET) represent the variability of almost benign lesions either secreting hormones occurring as a single lesion up to malignant lesions with metastatic potential. Treatment of NET is usually performed by surgical resection. Due to the rarity of NET, surgical treatment is mainly based on the experience and recommendations of experts and less on the basis of prospective randomized studies. In addition, the development and establishment of new surgical procedures is made more difficult by their rarity. The development of laparoscopic-assisted surgery has significantly improved the treatment of many diseases. Due to the well-known advantages of laparoscopic surgery, this method has also been increasingly used to treat NET. However, due to limited comparative data, the assumed superiority of laparoscopic surgery in the area NET remains often unclear or not yet proven. This review focuses on the present usage of laparoscopic techniques in the area of NET. Relating to the current literature, this review presents the evidence of various laparoscopic procedures for treatment of adrenal, pancreatic and intestine NET as well as extraadrenal pheochromocytoma and neuroendocrine liver metastases. Further, this review focuses on recent new developments of minimally invasive surgery in the area of NET. Here, robotic-assisted surgery and single-port surgery are promising approaches.