Synchronous liver metastasis at initial diagnosis of adrenal pheochromocytoma by CT: A case report

Zhang,Zhuo; Jin,Xuemei; Guo,Yuzhu; Li,Xiaoyu; Xu,Kaixuan; Jin,Guangyu

doi:10.3892/ol.2024.14462

Synchronous liver metastasis at initial diagnosis of adrenal pheochromocytoma by CT: A case report

Authors:
- Zhuo Zhang
- Xuemei Jin
- Yuzhu Guo
- Xiaoyu Li
- Kaixuan Xu
- Guangyu Jin
View Affiliations

Affiliations: Department of Radiology, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China, Department of Pathology, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
Published online on: May 17, 2024 https://doi.org/10.3892/ol.2024.14462
Article Number: 329

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Pheochromocytoma is a tumor of the sympathetic nervous system, characterized by atypical symptoms and signs. Pheochromocytoma metastases can be found in various tissues and organs. However, synchronous metastasis at the initial diagnosis of pheochromocytoma is rare. The present study described a case with synchronous liver metastasis at the initial diagnosis of adrenal pheochromocytoma based on imaging findings. A 41‑year‑old woman presented with liver pain and fatigue for 1 month. Physical examination showed increased blood pressure and heart rate with sinus tachycardia. Laboratory examination revealed normal levels of liver tumor markers and increased levels of serum or urine epinephrine and norepinephrine. CT examination revealed a large cystic solid mass in the right lobe of the liver and right adrenal gland, and the solid part of the mass was enhanced after enhancement. The pathological diagnosis was pheochromocytoma of the right adrenal gland with liver metastasis. The patient underwent right hepatectomy and right adrenal tumor resection. During the postoperative follow‑up, the patient's blood pressure and catecholamine levels were within the normal range. Three years after surgery, the CT examination revealed multiple liver metastases. Chemotherapy was administered to the patient. A year later, re‑examination revealed an increase and enlargement of the metastases, and the mass of the right adrenal gland remained similar to the previous one. After 6 months of follow‑up, the patient succumbed to recurrence and metastasis. Preoperative diagnosis of metastatic pheochromocytoma is challenging. This case mainly emphasizes that imaging findings can help the clinical diagnosis of metastatic pheochromocytoma.

View Figures

View References

1	Gruber M, Darr R and Eisenhofer G: Pheochromocytoma: Update on diagnosis and therapy. Dtsch Med Wochenschr. 139:486–490. 2014.(In German). View Article : Google Scholar : PubMed/NCBI
2	Reisch N, Peczkowska M, Januszewicz A and Neumann HP: Pheochromocytoma: Presentation, diagnosis and treatment. J Hypertens. 24:2331–2339. 2006. View Article : Google Scholar : PubMed/NCBI
3	Nölting S, Grossman A and Pacak K: Metastatic phaeochromocytoma: Spinning towards more promising treatment options. Exp Clin Endocrinol Diabetes. 127:117–128. 2019. View Article : Google Scholar : PubMed/NCBI
4	Soltani A, Pourian M and Davani BM: does this patient have pheochromocytoma? a systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 15:62015. View Article : Google Scholar : PubMed/NCBI
5	Hori T, Yamagiwa K, Hayashi T, Yagi S, Iida T, Taniguchi K, Kawarada Y and Uemoto S: Malignant pheochromocytoma: Hepatectomy for liver metastases. World J Gastrointest Surg. 5:309–313. 2013. View Article : Google Scholar : PubMed/NCBI
6	Ayala-Ramirez M, Feng L, Johnson MM, Ejaz S, Habra MA, Rich T, Busaidy N, Cote GJ, Perrier N, Phan A, et al: Clinical risk factors for malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: Primary tumor size and primary tumor location as prognostic indicators. J Clin Endocrinol Metab. 96:717–725. 2011. View Article : Google Scholar : PubMed/NCBI
7	Wei S, Wu D and Yue J: Surgical resection of multiple liver metastasis of functional malignant pheochromocytoma: A case report and literature review. J Cancer Res Ther. 9 (Suppl):S183–S185. 2013. View Article : Google Scholar : PubMed/NCBI
8	Morikawa T, Suzuki M, Unno M, Endo K, Katayose Y and Matsuno S: Malignant pheochromocytoma with hepatic metastasis diagnosed 10 years after a resection of the primary incidentaloma adrenal lesion: Report of a case. Surgery Today. 31:80–84. 2001. View Article : Google Scholar : PubMed/NCBI
9	Hidaka S, Hiraoka A, Ochi H, Uehara T, Ninomiya T, Miyamoto Y, Hasebe A, Tanihira T, Tanabe A, Ichiryu M, et al: Malignant pheochromocytoma with liver metastasis treated by transcatheter arterial chemo-embolization (TACE). Intern Med. 49:645–651. 2010. View Article : Google Scholar : PubMed/NCBI
10	Tanaka S, Ito T, Tomoda J, Higashi T, Yamada G and Tsuji T: Malignant pheochromocytoma with hepatic metastasis diagnosed 20 years after resection of the primary adrenal lesion. Intern Med. 32:789–794. 1993. View Article : Google Scholar : PubMed/NCBI
11	Nicoś M, Jarosz B, Krawczyk P, Wojas-Krawczyk K, Kucharczyk T, Sawicki M, Pankowski J, Trojanowski T and Milanowski J: Screening for ALK abnormalities in central nervous system metastases of non-small-cell lung cancer. Brain Pathol. 28:77–86. 2018. View Article : Google Scholar : PubMed/NCBI
12	Keiser HR, Goldstein DS, Wade JL, Douglas FL and Averbuch SD: Treatment of malignant pheochromocytoma with combination chemotherapy. Hypertension. 7:118–124. 1985. View Article : Google Scholar
13	Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K and Young WF Jr; Endocrine Society, : Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 99:1915–1942. 2014. View Article : Google Scholar : PubMed/NCBI
14	Motta-Ramirez GA, Remer EM, Herts BR, Gill IS and Hamrahian AH: Comparison of CT findings in symptomatic and incidentally discovered pheochromocytomas. AJR Am J Roentgenol. 185:684–688. 2005. View Article : Google Scholar : PubMed/NCBI
15	Canu L, Van Hemert JAW, Kerstens MN, Hartman RP, Khanna A, Kraljevic I, Kastelan D, Badiu C, Ambroziak U, Tabarin A, et al: CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma. J Clin Endocrinol Metab. 104:312–318. 2019. View Article : Google Scholar : PubMed/NCBI
16	Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT, Pitman MB, Harisinghani M, Mueller PR and Hahn PF: Low-density pheochromocytoma on CT: A mimicker of adrenal adenoma. AJR Am J Roentgenol. 181:1663–1668. 2003. View Article : Google Scholar : PubMed/NCBI
17	Adam SZ, Nikolaidis P, Horowitz JM, Gabriel H, Hammond NA, Patel T, Yaghmai V and Miller FH: Chemical shift MR imaging of the adrenal gland: Principles, pitfalls, and applications. Radiographics. 36:414–432. 2016. View Article : Google Scholar : PubMed/NCBI
18	Ahmed AA, Thomas AJ, Ganeshan DM, Blair KJ, Lall C, Lee JT, Morshid AI, Habra MA and Elsayes KM: Adrenal cortical carcinoma: Pathology, genomics, prognosis, imaging features, and mimics with impact on management. Abdom Radiol (NY). 45:945–963. 2020. View Article : Google Scholar : PubMed/NCBI
19	Herr K, Muglia VF, Koff WJ and Westphalen AC: Imaging of the adrenal gland lesions. Radiol Bras. 47:228–239. 2014. View Article : Google Scholar : PubMed/NCBI
20	Tanabe A, Naruse M, Nomura K, Tsuiki M, Tsumagari A and Ichihara A: Combination chemotherapy with cyclophosphamide, vincristine, and dacarbazine in patients with malignant pheochromocytoma and paraganglioma. Horm Cancer. 4:103–110. 2013. View Article : Google Scholar : PubMed/NCBI