Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Huge pheochromocytoma presented with paraaortic lymph node and spine metastases

척추와 대동맥주위 림프절로 전이한 거대 갈색세포종

  • Park, Yeon Won (Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Moon, Han Ju (Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Han, Jung Suk (Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Han, Ji Min (Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Park, Jong Wook (Department of Urology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Ku, Yun Hyi (Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences)
  • 박연원 (한국원자력의학원 원자력병원 내과) ;
  • 문한주 (한국원자력의학원 원자력병원 내과) ;
  • 한정석 (한국원자력의학원 원자력병원 내과) ;
  • 한지민 (한국원자력의학원 원자력병원 내과) ;
  • 박종욱 (한국원자력의학원 원자력병원 비뇨기과) ;
  • 구윤희 (한국원자력의학원 원자력병원 내과)
  • Received : 2016.04.11
  • Accepted : 2016.08.18
  • Published : 2017.12.31
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Abstract

Approximately 10-15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a $10.0{\times}9.5{\times}7.5cm$ sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.

Keywords

References

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