RESUMO
We present a case of synchronous malignant pheochromocytoma in bilateral adrenal glands. A 73- year-old man presented to our hospital with bilateral adrenal masses incidentally found during abdominal ultrasonography examination for an unrelated issue. The patient had a 30-year history of hypertension and paroxysmal atrial fibrillation. Computed tomography and magnetic resonance imaging showed heterogeneous tumors in bilateral adrenal glands and an enlarged para-aortic lymph node. Hormonal examinations revealed a high value of urinary catecholamines. Metaiodobenzylguanidine (MIBG) scintigraphy showed increased uptake in bilateral adrenal glands and the lymph node. Both adrenal tumors and the node were surgically removed. Pathological examination revealed histologically distinct tissue between the two adrenal tumors. The patient received five cycles of adjuvant chemotherapy, consisting of cyclophosphamide, vincristine, and dacarbazine. The patient has been in remission for 32 months following surgical treatment.
Assuntos
Neoplasias das Glândulas Suprarrenais , Neoplasias Primárias Múltiplas , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/cirurgia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Humanos , Metástase Linfática , Masculino , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/cirurgia , Feocromocitoma/tratamento farmacológico , Feocromocitoma/cirurgia , Indução de Remissão , Resultado do TratamentoRESUMO
A 39-year-old woman was referred to our hospital due to left abdominal mass which was incidentally pointed out by computed tomographic (CT) scan. She had no symptoms. Abdominal enhanced CT showed an 85 mm solid mass, which had clustered calcifications and was enhanced weakly. Magnetic resonance imaging showed a relatively well-circumscribed mass 125 mm in maximum diameter, in the left kidney. The left adrenal gland could not be identified. An endocrinological examination was done. In the 24-hour specimen of urine, dopamine and vanillylmandelicacid levels were abnormally high. We surgically removed the tumor, because malignancy including adrenal carcinoma was not completely excluded. An additional 1cm tumor which mimics lymph node metastasis along the aorta was found during the operation and removed. Postoperative histopathological findings revealed the tumor clearly distinguished from the adrenal gland and was composed of mature nerve fibers and ganglion cells. The other tumor had the same histology without any lymph node tissue. On the basis of this finding, it was diagnosed as multifocal retroperitoneal ganglioneuroma.