Pheochromocytoma (PCC) is a neuroendocrine tumor that mainly arises from the medulla of the adrenal gland. Some PCCs become malignant and metastasize to other organs. For example, it typically involves skeletal system, liver, lung, and regional lymph nodes. However, only a few cases of PCC with brain metastasis have been reported worldwide. We report a case of metastatic brain tumor from PCC in South Korea in 2016. A 52-year-old man presented with headache, dizziness and motor aphasia. He had a medical history of PCC with multi-organ metastasis, previously underwent several operations, and was treated with chemotherapy and radiotherapy. Brain MRIs showed a brain tumor on the left parietal lobe. Postoperative pathology confirmed that the metastatic brain tumor derived from malignant PCC. This is the first report PCC with brain metastasis in South Korea.
Adrenal Glands ; Aphasia, Broca ; Brain Neoplasms ; Brain* ; Dizziness ; Drug Therapy ; Headache ; Humans ; Korea ; Liver ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Neuroendocrine Tumors ; Parietal Lobe ; Pathology ; Pheochromocytoma* ; Radiotherapy

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 10.0×9.5×7.5 cm 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.
Adrenal Gland Neoplasms ; Adrenal Glands ; Aged ; Back Pain ; Catecholamines ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Lymph Nodes* ; Magnetic Resonance Imaging ; Metastasectomy ; Neoplasm Metastasis* ; Norepinephrine ; Pathology ; Pheochromocytoma* ; Recurrence ; Spine*

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 10.0×9.5×7.5 cm 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.
Adrenal Gland Neoplasms ; Adrenal Glands ; Aged ; Back Pain ; Catecholamines ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Lymph Nodes ; Magnetic Resonance Imaging ; Metastasectomy ; Neoplasm Metastasis ; Norepinephrine ; Pathology ; Pheochromocytoma ; Recurrence ; Spine

PURPOSE: In this study, we reviewed 16 cases of adrenalectomy, focusing specifically on the surgical outcomes and clinical courses.METHODS: The data from 16 patients who underwent an adrenalectomy at our hospital between January 2007 to December 2016 were retrospectively analyzed based on their medical records. Data available for each patient included age, sex, tumor location, length of postoperative hospital stay, tumor size, tumor pathology, final diagnosis, operation time, operative blood loss, and type of operation.RESULTS: The study population consisted of eight males and eight females, with a mean age of 58.00±11.34 years (range, 33–76 years). The mean tumor size was 2.78±2.02 cm (range, 0.5–7 cm). Fourteen patients were diagnosed with functional adrenal tumors and two with nonfunctional adrenal tumors. Compared to laparoscopic adrenalectomy, open surgery resulted in a statistically significantly longer operating time, increased operative blood loss, and a longer postoperative hospital stay.CONCLUSION: If the hormonal activity of adrenal tumors is not confirmed, the tumor should be considered functional when accompanied by related symptoms and an adrenalectomy should be performed. In addition, we suggest that a laparoscopic adrenalectomy is superior to an open adrenalectomy in terms of recovery after surgery, despite the small number of cases evaluated. Open adrenalectomy should be considered following comprehensive consideration of the patient's condition, such as accompanying surgery or metastatic cancer.
Adrenal Glands ; Adrenalectomy ; Diagnosis ; Female ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Male ; Medical Records ; Operative Time ; Pathology ; Retrospective Studies

Adrenal Cortex Neoplasms ; complications ; Adrenal Gland Neoplasms ; complications ; Adrenal Glands ; pathology ; Adrenocortical Adenoma ; complications ; Humans ; Pheochromocytoma ; complications

In patients with primary aldosteronism who have bilateral adrenal incidentalomas, it is important to identify which adrenal gland is secreting excess aldosterone. Traditionally, adrenal vein sampling (AVS) has been performed for lateralization despite its invasiveness. Here we report a case of bilateral adrenal incidentaloma in which 18-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) was used to identify the functional adrenal mass. A 53-yr-old man was referred to our clinic due to bilateral adrenal incidentalomas (right: 1 cm, left: 2.5 cm) on computed tomography (CT). Given his history of colon cancer, FDG-PET/CT scanning was used to rule out metastasis. Although there was focal hot uptake lesion in the right adrenal gland, the patient was suspected primary aldosteronism clinically more than metastasis because of the patient's underlying hypertension with hypokalemia. It was consistent with the results of AVS. Based on these findings, we propose that FDG-PET/CT can be used instead of AVS to identify the source of primary aldosteronism between two bilateral adrenal incidentalomas.
Adrenal Gland Neoplasms/*diagnosis/pathology/radionuclide imaging ; Adrenal Glands/pathology/surgery ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Hyperaldosteronism/*diagnosis/pathology ; Hypertension/diagnosis ; Hypokalemia/diagnosis ; Male ; Middle Aged ; Positron-Emission Tomography and Computed Tomography

Adrenal Glands ; pathology ; Codon, Nonsense ; Exons ; Female ; Humans ; Infant ; Liver ; pathology ; Spleen ; pathology ; Sterol Esterase ; genetics ; Tomography, X-Ray Computed ; Wolman Disease ; diagnostic imaging ; genetics ; pathology

Herein, we report a neonatal case of an extra-renal non-cranial malignant rhabdoid tumor with simultaneous tumor in the adrenal gland, which was initially diagnosed with hemangioma. The patient showed a soft tissue mass on the chin at birth which grew rapidly with invasion of lower lip. Despite multimodal treatment including surgery, chemotherapy and high dose chemotherapy followed by autologous stem cell transplantation, the patient died of disease progression at the age of 20 months finally. The clinical presentation, diagnosis, pathology, treatment, and prognosis for this case are discussed.
Adrenal Glands ; Chin ; Combined Modality Therapy ; Diagnosis ; Disease Progression ; Drug Therapy ; Hemangioma ; Humans ; Infant, Newborn ; Lip ; Neoplasm Metastasis ; Parturition ; Pathology ; Prognosis ; Rhabdoid Tumor ; Stem Cell Transplantation

BACKGROUNDAlveolar echinococcosis located in the adrenal gland can be considered a rare and aggressive infestation that radiologically and macroscopically mimics a malignant neoplasm. Its pathogenesis is poorly understood. This paper describes its clinical and radiological aspects and discusses its proper management.

METHODSThe records of two patients with adrenal gland alveolar echinococcosis who were diagnosed and treated in our center in 2009 were evaluated.

RESULTSNeither patient showed any signs of recurrence following radical surgical treatment and postoperative oral anthelmintic therapy.

CONCLUSIONRadical surgery can be a feasible, effective management option that results in a good prospective outcome.

Adrenal Glands ; pathology ; surgery ; Echinococcosis, Hepatic ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged

A 29-yr-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. The initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient started empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathological finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy. Lymphoma mainly involving adrenal gland in the early stage of the disease is rare and the vast majority of cases that have been reported were of B-cell origin. From this case it is suggested that extra-nodal NK/T-cell lymphoma should be considered as a cause of bilateral adrenal masses although it is rare.
Adrenal Gland Neoplasms/*diagnosis/pathology ; Adrenal Glands/*blood supply ; Adult ; Diagnosis, Differential ; Hemorrhage/diagnosis ; Humans ; *Killer Cells, Natural ; Lymph Nodes/pathology ; Lymphoma, T-Cell/*diagnosis/pathology ; Male ; *T-Lymphocytes ; Tuberculosis, Endocrine/diagnosis