Pheochromocytoma Is A Rare Tumor; Single Center Experience

Year 2014, , 27 - 32, 01.01.2014

Ebubekir Gündeş Murat Çakır Halil İbrahim Taşcı Ahmet Tekin Faruk Aksoy

https://doi.org/10.5505/abantmedj.2014.73644

Abstract

OBJECTIVE: The aim of our study is to review our clinical experiences with pheochromocytoma cases which are rare tumors with neuroectodermal origins.METHODS: The clinical, lab, radiological, and surgical data of a total of 14 patients diagnosed with pheochromocytoma between 2005 and 2012 at our clinic were evaluated retrospectively.RESULTS: Eight out of 14 patients who received treatment at our clinic having been diagnosed with pheochromocytoma were male, while 6 were female and their ages ranged between 18 and 60. 10 71% of the patients had hypertension. The most frequent symptom was abdominal pain 57% . Eight tumors were located on the left 57% and five were located on the right 35% , while one tumor 7% had bilateral adrenal location. The imaging techniques used in diagnosis were ultrasonography and computerized tomography. None of our patients had a history of familial pheochromocytoma. All the hypertensive patients were administered pre-op phenoxybenzamine and propranolol. The surgical procedures were performed by laparoscopy in nine cases, and by laparotomy in five. Post-op remission was observed in 80% of the hypertensive patients. Malign pheochromocytoma was detected in two patients. The follow-up of all the patients was conducted through testing the VMA level in 24-hour urine and through abdominal CT regularly. The follow-ups revealed that one case had liver metastasis.CONCLUSION: This study aims at demonstrating that pheochromocytoma has a non-specific and unstable clinic. The tumor is frequently found randomly. Although pheochromocytoma is a rare tumor, it can be treated through a right evaluation, good pre-op preparation, and complete surgical excision.

Keywords

Adrenal mass, neuroectodermal tumor, pheochromocytoma

Nadir Görülen Bir Tümör Feokromasitoma; Tek Merkez Deneyimi

Abstract

AMAÇ: Nöroektodermal orijinli nadir bir tümör olan Feokromasitomalı olgulardaki klinik deneyimlerimizi gözden geçirmektir.YÖNTEMLER: 2005 ve 2012 yılları arasında kliniğimizde feokromasitoma tanısı konmuş 14 hastanın klinik, laboratuar, radyolojik ve cerrahi verileri geriye dönük olarak değerlendirilmiştir. BULGULAR: Kliniğimizde feokromasitoma tanısı ile tedavi gören 14 hastanın 8’i erkek, 6’sı kadın olup yaşları 18 ve 60 arasında değişmekte idi. Hastaların 10 %71 ’unda hipertansiyon mevcuttu. En sık semptom karın ağrısı %57 idi. Yerleşim yerleri açısından sekizi %57 solda, beşi %35 sağ ve birinde %7 tümör bilateral adrenal yerleşimliydi. Tanıda kullanılan görüntüleme yöntemi ultrasonografisi ve bilgisayarlı tomografiydi. Hastalarımızın hiç birisinde ailesel feokromasitoma sendromu ile ilişkili değildi. Bütün hipertansif hastalara preoperatif fenoksibenzamin ve propranolol verildi. Cerrahi işlem dokuz olguda laparoskopik, beşinde ise laparotomi ile gerçekleştirildi. Hipertansif hastaların % 80’inde cerrahi sonrasında remisyon gözlendi. İki hastada malign feokromasitoma tespit edildi. Tüm hastaların takibi 24 saatlik idrarda VMA düzeyi ve batın BT ile düzenli olarak yapıldı. Takiplerde olguların birinde karaciğer metastazı tespit edildi.SONUÇ: Bu çalışma ile feokromasitomanın nonspesifik ve değişken bir kliniğinin olduğu gösterilmek istendi. Sıklıkla tümör rastlantısal olarak bulunmaktadır. Feokromasitoma nadir bir tümör olmasına rağmen, doğru bir değerlendirme, iyi bir preoperatif hazırlık ve tam cerrahi eksizyon ile tedavi edilebilir.

Keywords

Adrenal kitle, nöroektodermal tümör, feokromasitoma

References

• 1. Samaan NA, Hickey RC, Shutts PE. Diagnosis, localization and management of pheochromocytoma - pitfalls and follow-up in 41 patients. Cancer 1988; 62: 2451- 60.
• 2. Werbel SS, Ober KP. Pheochromocytoma - update on diagnosis, localization and management. Med Clin North Am 1995; 79: 131- 53.
• 3. Atuk NO. Pheochromocytoma - diagnosis, localization and treatment. Hosp Pract 1983; 18: 187- 202.
• 4. Welbourn RB. Early surgical history of pheochromocytoma. Br J Surg 1987; 74: 594- 6.
• 5. Othman G, Thomas VT. Extraadrenal pheochromocytoma - a case report. J Kuwait Med Assoc 1997; 29: 329- 32.
• 6. Rosamond TL, Hamburg MS, Vacek JL, Borkon AM. Intrapericardial pheochromocytoma. Am J Cardiol 1992; 70: 700- 2.
• 7. Hamilton BH, Francis IR, Gross BH, Korobkin M, Shapiro B, Shulkin BL, Deeb CM, Orringer MB. Intrapericardial paragangliomas: Imaging features. AJR Am J Roentgenol 1997; 168: 109- 13.
• 8. Lee HH, Brenner WI, Vardhan I, Hyatt J, Terlecki M. Cardiac Pheochromocytoma originating in the internal septum. Chest 1990; 97: 760- 2.
• 9. Dennis PJ, Lewandowski AE, Rohner TJ, Weidner WA, Mamourian AC, Stern DR. Pheochromocytoma of the prostate - an unusual location. J Urol 1989; 141: 130- 2.
• 10. Pullerits J, Ein S, Balfe JW. Anaesthesia for Pheochromocytoma. Can J Anaesth. 1988; 35: 526- 34.
• 11. Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF. Year of diagnosis, features at presentation and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab 2005; 90: 2110- 6.
• 12. Sever PS, Roberts JC, Snell ME. Pheochromocytoma. Clin Endocrinol Metab 1980; 9: 543- 68.
• 13. Lo CY, Lam KY, Wat MS, Lam KS. Adrenal pheochromocytoma remains a frequently overlooked diagnosis. Am J Surg 2000; 179: 212- 5.
• 14. Latronico AC, Chrousos GP. Extensive personal experience - adrenocortical tumors. J Clin Endocrinol Metab 1997; 82: 1317- 24.
• 15. Plouin PF, Chatellier G, Rougeot MA, Duclos JM, Pagny JY, Corvol P, Ménard J. Recent developments in pheochromocytoma diagnosis and imaging. Adv Nephrol Necker Hosp 1988; 17: 275- 86.
• 16. Fonseca V, Bouloux PM. Pheochromocytoma and paraganglioma. Baillieres Clin Endocrinol Metab 1993; 7: 509- 44.
• 17. Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P. Biochemical diagnosis of pheochromocytoma - which test is best? JAMA 2002; 287: 1427-34.
• 18. Grouzmann E, Drouard-Troalen L, Baudin E, Plouin PF, Muller B, Grand D, Buclin T. Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma. Eur J Endocrinol 2010; 162: 951-60.
• 19. Sawka AM, Jaeschke R, Singn RJ, Young WF Jr. A comparison of biochemical tests for pheochromocytoma - measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab 2003; 88: 553- 8.
• 20. Welch TJ, Sheedy PF, Van Heerden JA, Sheps SG, Hattery RR, Stephens DH. Pheochromocytoma - value of computed tomography. Radiology 1983; 148: 501- 3.
• 21. Van Heerden JA, Sheps SG, Hamberger B, Sheedy PF 2 nd, Poston JG, ReMine WH. Pheochromocytoma - current status and changing trends. Surgery 1982; 91: 367- 73.
• 22. Plouin PF, Chatellier G, Fofol I, Corvol P. Tumor recurrence and hypertension persistence after successful pheochromocytoma operation. Hypertension 1997; 29: 1133- 9.