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

OBJECTIVETo evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.

METHODSTo analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.

RESULTSThe lesions (benign=28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7). The tumors showed heterogeneous density on unenhanced CT (n=25). Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast. The enhancement patterns included whole enhancement (n=9), solid area enhancement (n=12), peripheral enhancement (n=1), and spotted enhancement (n=1). The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement. The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3). Besides that the morphology had statistical significance (P=0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.

CONCLUSIONSRetroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes. Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

Adrenal Gland Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; Diagnosis, Differential ; Humans ; Hypertension ; Image Enhancement ; Pheochromocytoma ; diagnostic imaging ; pathology ; Retroperitoneal Space ; Retrospective Studies ; Tomography, X-Ray Computed

We present two cases of adrenocortical oncocytomas that were well-delineated on multi-detector computed tomography and magnetic resonance imaging. The images showed a well-enhanced large mass with multiple stippled calcifications in a 10-yr-old girl who was consulted due to precocious puberty. A well-enhanced solid mass with necrotic components was incidentally noticed in a 54-yr-old man. These lesions were resected and diagnosed as adrenocortical oncocytomas through immunohistochemical studies and electron microscopy. Adrenocortical oncocytomas are rare disease entities, therefore, we report these interesting, rare adrenocortical oncocytomas here with radiologic findings, and discuss differential diagnosis.
Adenoma, Oxyphilic/*diagnosis/pathology/radiography ; Adrenal Gland Neoplasms/*diagnosis/pathology/radiography ; Child ; Diagnosis, Differential ; Female ; Hemorrhage ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

We report a case of a 74-year-old female with myxoid adrenocortical adenoma which showed different magnetic resonance imaging findings compared to those of a typical adrenocortical adenoma. The myxoid change in the adrenocortical adenoma is a rare form of degeneration. It presents a considerable diagnostic challenge to both radiologists and clinicians because it can mimic other adrenal tumor types on imaging. The MRI findings of the presented case included a high signal intensity on T2-weighted images similar to that of fluid and delayed progressive enhancement.
Adenoma/*diagnosis/pathology ; Adrenal Gland Neoplasms/*diagnosis/pathology ; Adrenocortical Adenoma/*diagnosis/pathology ; Aged ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Rare Diseases/*diagnosis/pathology

Actins ; metabolism ; Adrenal Gland Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Desmin ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Leiomyosarcoma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Reoperation ; Tomography, X-Ray Computed ; Vimentin ; metabolism

Pheochromocytoma is a rare cause of hypertension in children. Hypertension is one of the common reasons of posterior reversible encephalopathy. Intracerebral hemorrhage is a serious and unexpected complication of hypertensive encephalopathy due to pheochromocytoma, and very rarely seen in the childhood. Intracerebral hemorrhages should be searched if there are hypertensive reversible signal changes on the brain. Susceptibility weighted imaging (SWI) is a more sensitive method than conventional MRI when demonstrating cerebral microhemorrhagic foci. This is the first report of SWI findings on intracerebral hemorrhages in basal ganglia, brain stem and periventricular white matter due to hypertensive encephalopathy in a child with pheochromocytoma.
Adolescent ; Adrenal Gland Neoplasms/*complications/diagnosis ; Brain/*pathology ; Diagnosis, Differential ; Female ; Humans ; Hypertensive Encephalopathy/*diagnosis/etiology ; Magnetic Resonance Imaging/*methods ; Pheochromocytoma/*complications/diagnosis

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

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.
Adrenal Gland Neoplasms/*diagnosis/radionuclide imaging/secondary ; Aged, 80 and over ; Carcinoma, Hepatocellular/*pathology/surgery ; Humans ; Liver Neoplasms/*pathology/surgery ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

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