OBJECTIVE: To explore the surgical strategy and experience of reoperation for pheochromocytoma and paraganglioma which is very challenging. METHODS: The clinical data of 7 patients with pheochromocytoma and paraganglioma who underwent reoperation in Department of Urology, Peking University Third Hospital from August 2016 to February 2021 were analyzed retrospectively. There were 4 males and 3 females, with an average age of (44.1±11.5) years (28-60 years), 6 cases on the right side and 1 case on the left side. The causes of the operations included: (1) 2 cases of tumor recurrence after resection; (2) The primary operations failed to completely remove the tumors in 3 cases, because the tumors were large and closely related to blood vessels. (3) Pheochromocytoma and paraganglioma wasn't diagnosed before primary operation, therefore, drug preparation wasn't prepared. Two cases were interrupted by severe blood pressure fluctuations during the primary operations. Imaging evaluation, catecholamine biochemical examination and adequate adrenergic α receptor blockers were administrated in all the cases. The surgical approaches included open transperitoneal surgery in 4 cases, robot-assisted laparoscopy in 1 case and retroperitoneal laparoscopy in 2 cases. The innovative techniques included mobilization of the liver, inferior vena cava transection and anastomosis, and transection of left renal vein. RESULTS: The average tumor size was (8.0±3.2) cm (3.6-13.9 cm). The median interval between the reoperation and the primary operation was 9 months (IQR: 6, 19 months). The median operation time was 407 min (IQR: 114, 430 min) and the median blood loss was 1 500 mL (IQR: 20, 3 800 mL). Operations of 5 cases were performed successfully, and 1 case failed only by exploration during the operation. One case died perioperatively. There were 5 cases of intraoperative blood transfusion, the median transfusion volume of red blood cells was 800 mL (IQR: 0, 2 000 mL). One case experienced postoperative lymphorrhagia, and recovered after conservative treatment. The renal function was normal in 2 cases after resection and anastomosis of inferior vena cava or transection of left renal vein. The average postoperative hospital stay was (7.2±3.3) d (4-13 d). The median follow-up time of 6 patients was 33.5 months (IQR: 4.8, 48.0 months). The case who failed in the reoperation still survived with tumor and there was no recurrence in the rest of the patients. CONCLUSION The reoperation of pheochromocytoma and paraganglioma, which can not be resected in the primary operation or recurred postoperatively, is difficult with high risk of hemorrhage, and there is a risk of failure and perioperative death. Different surgical approaches and strategies need to be adopted based on the different situation.
Adrenal Gland Neoplasms/surgery* ; Adult ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Paraganglioma/surgery* ; Pheochromocytoma/surgery* ; Reoperation ; Retrospective Studies

Adrenalectomy ; Female ; Humans ; Pheochromocytoma ; diagnosis ; surgery ; Tachycardia, Ventricular ; diagnosis ; Tomography, X-Ray Computed

No abstract available.
Adrenal Cortex Function Tests ; *Adrenal Cortex Neoplasms/complications/diagnosis/metabolism/surgery ; *Adrenal Gland Neoplasms/complications/diagnosis/metabolism/surgery ; Adrenalectomy ; *Adrenocortical Adenoma/complications/diagnosis/metabolism/surgery ; Biopsy ; Cushing Syndrome/diagnosis/etiology ; Female ; Humans ; Immunohistochemistry ; *Incidental Findings ; Middle Aged ; *Neoplasms, Multiple Primary/complications/diagnosis/metabolism/surgery ; *Pheochromocytoma/complications/diagnosis/metabolism/surgery ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/metabolism

Adrenal gland tumours in pregnancy are very rare occurrences and have highly variable clinical presentations. The timely diagnosis of adrenal tumours in pregnancy is extremely important, as failure to do so may lead to fatality. As there is limited published literature on adrenal tumours in pregnancy and no consensus on its management, the management of such patients with regard to medical and surgical treatments, as well as timing of delivery, must therefore be individualised and carried out with multidisciplinary expertise. We present two cases of adrenal tumours in pregnancy, both with favourable outcomes and variable gestations. Our first and second cases discuss a large phaeochromocytoma and a cortisol-secreting adrenal cortical adenoma in pregnancy, respectively.
Adrenal Gland Neoplasms ; diagnosis ; surgery ; Adrenalectomy ; Adult ; Biomarkers ; blood ; urine ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Magnetic Resonance Imaging ; Pheochromocytoma ; diagnosis ; surgery ; Pregnancy ; Pregnancy Complications, Neoplastic ; diagnosis

Adrenal Gland Neoplasms ; surgery ; Adrenalectomy ; methods ; Adult ; Female ; Humans ; Kidney ; abnormalities ; Laparoscopy ; Multiple Endocrine Neoplasia Type 2a ; surgery ; Pheochromocytoma ; surgery

Extra-adrenal pheochromocytoma is rare and presents variable symptoms. Its difficulty to diagnosis delays appropriate treatment. We would like to report an unusual case of extra-adrenal pheochromocytoma. The patient came to the emergency room with dyspnea, palpitation, and cyanosis. He had a history of hospitalization for Fontan operation due to congenital heart disease. Despite medication, his blood pressure remained high. After additional laboratory and image exams, he was diagnosed with extra-adrenal pheochromocytoma and had surgical treatment. The final pathology report was extra-adrenal pheochromocytoma with high risk of malignancy. The postoperative course was uneventful and showed normal laboratory results even after 3 months of outpatient follow-up. Extra-adrenal pheochromocytoma presents variable symptoms. We should consider endocrinologic diseases like extra-adrenal pheochromocytoma in cases presenting with palpitation and high blood pressure, even with a past history of cardiac surgery.
Adolescent ; Blood Pressure ; Cyanosis ; Dyspnea ; Emergencies ; Follow-Up Studies ; Fontan Procedure ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Hospitalization ; Humans ; Hypertension ; Outpatients ; Paraganglioma ; Pheochromocytoma ; Porphyrins ; Thoracic Surgery

PURPOSE: Single port laparoscopic surgery is an area of active investigation in abdominal surgery. A standard procedure for single port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes following laparoscopic adrenalectomy via mono-port (LAMP). METHODS: Between March 2009 and December 2009, 10 patients underwent LAMP at Kangbuk Samsung Hospital. The same surgeon performed all surgeries. The first 5 cases underwent LAMP using an Alexis Wound Retractor (Applied Medical, Rancho Santa Margarita, CA, USA) with surgical gloves, and others were done with an OCTO Port (Dalim Surgnet, Korea). RESULTS: Of the 10 patients, 5 were male and 5 were female. The mean age was 43.7±9.9 years (range, 34~62), and the mean BMI was 24.1±4.0 kg/m² (Range, 17.1 ~30.0). The mean tumor size was 32.5±16.9 mm (range, 12~60),mean operative time was 127.0±29.5 min (range, 90~180), and mean hospital stay was 4.5 days (range, 3~7). Three patients were diagnosed with non-functioning cortical adenoma, 3 with Cushing's syndrome, 2 patients with pheochromocytoma, and others with primarily hyperaldosteronism and myelolipoma. Major postoperative morbidity, blood transfusions, or conversion to open surgery did not occur. CONCLUSION: The outcome of LAMP demonstrates the safety and feasibility of this procedure. With increasing surgeon experience and refinement in instrument technology, we believe LAMP is likely to become a standard approach to adrenal disease.
Adenoma ; Adrenalectomy* ; Blood Transfusion ; Conversion to Open Surgery ; Cushing Syndrome ; Female ; Gloves, Surgical ; Humans ; Hyperaldosteronism ; Laparoscopy ; Length of Stay ; Male ; Myelolipoma ; Operative Time ; Pheochromocytoma ; Retrospective Studies ; Wounds and Injuries

Adrenal Gland Neoplasms ; surgery ; Adult ; Cystectomy ; methods ; Humans ; Laparoscopy ; methods ; Male ; Pheochromocytoma ; surgery ; Urinary Bladder Neoplasms ; surgery

BACKGROUNDAdrenal ganglioneuroma is a rare adrenal pathogenic disease with difficult differential diagnosis from adrenal pheochromocytoma. Currently, very limited literature is available to allow a differential diagnosis of these two conditions from each other. This study aimed to evaluate the clinical profile, differential diagnosis and surgical treatments of both conditions.

METHODSClinical characteristics of 36 patients with adrenal pheocheomocytoma and 18 patients with adrenal ganglioneuroma were analyzed. Data from CT scans and surgical treatments from 1999 to 2007 were collected. Endocrine hormone tests and (131)I-metaiodobenzylguanidine (MIBG) were performed. Neither (131)I-MIBG nor endocrine hormone tests were available in 9 cases of asymptomatic adrenal ganglioneuroma with tumor size less than 4 cm and there were negative findings from contrast enhanced CT scans. The level of urine catecholamine of patients was compared by one-way analysis of variance.

RESULTSTe mean age of patients in the adrenal ganglioneuroma group was 41.2 years (16 - 67 year) and in the adrenal pheochromocytoma patients 38 years (17 - 74 year). Contrast enhanced CT showed that the foci were intensified in 5 cases (27.8%) of adrenal ganglioneuroma and there were obvious contrast indications in 30 (83.3%) of the pheochromocytoma. Catecholamine levels in a 24-hour urine sample were normal in 4 patients with adrenal ganglioneuroma and increased in 36 (100%) cases with adrenal pheochromocytoma. (131)I-MIBG nuclear scan showed negative results in 4 patients (100%) with adrenal ganglioneuroma and positive results in 25 (96.2%) with adrenal pheochromocytom. Laparoscopy for adrenal tumors was performed through a transperitoneal or retroperitoneal approach during a follow-up period of (43 +/- 6) months, and all cases survived well.

CONCLUSIONSCT, urinary catecholamine and (131)I-MIBG are standard and efficient tools for differential diagnosis of adrenal ganglioneuroma from pheochromocytoma. Laparoscopic surgery can be performed through a transperitoneal or retroperitoneal approach depending on the finding of CT scans. Open surgery is necessary for patients with blood loss of more than 800 ml and violent fluctuation of intraoperative blood pressure.

Adolescent ; Adrenal Gland Neoplasms ; diagnosis ; surgery ; Adult ; Aged ; Female ; Ganglioneuroma ; diagnosis ; surgery ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Pheochromocytoma ; diagnosis ; surgery ; Retrospective Studies ; Young Adult

OBJECTIVEThe purpose of this study was to assess the imaging characteristics of abdominal pheochromocytoma in multiphasic spiral CT scanning, and to determine whether these image characteristics can aid in differentiating pheochromocytoma from other types of tumors or not.

METHODSThe image data of dynamic enhanced CT of 79 pathologically confirmed pheochromocytomas in 70 patients were retrospectively reviewed.

RESULTSAmong the 70 patients, there were 41 patients with endocrine symptoms related to pheochromocytoma, 15 had a latent pheochromocytoma and the remaining 14 cases presented with a non-functioning pheochromocytoma. There were totally 79 tumors in 70 patients, with a single lesion in 63 cases, while multiple lesions in the other 7. Sixty cases had a tumor located in the adrenal gland, while 8 in retroperitoneal space, and 2 cases had both intraadrenal and ectopic lesions simultaneously. Sixty patients had a benign pheochromocytoma, the other 10 had a malignant one or relapse after operation. The average size of the tumor was 5.8 cm (range, 2 approximately 15 cm in the longest diameter). Seventy-seven pheochromocytomas had a well defined boundary except two big ones with a unclear margin, which were finally proven to be malignant. Homogeneous enhancement was found in 6 lesions with a diameter

CONCLUSIONApproximately half of the abdominal pheochromocytomas are lack of endocrine symptoms related with their tumors. However, they may display some typical CT characteristics, such as that a small lesion is often homogeneous but hypervascular, a larger tumor may present hemorrhage, necrosis, and cystic change with rich or moderate blood supply. However, when a small tumor has moderate blood supply, it should be differentiated with an adrenal adenoma; when a big one has moderate blood supply, it should be differentiated with other malignant tumors. Furthermore, a part of malignant pheochromocytomas is really difficult to be differentiated from some benign lesions by spiral CT images alone.

Adenoma ; blood supply ; diagnostic imaging ; surgery ; Adolescent ; Adrenal Gland Neoplasms ; blood supply ; diagnostic imaging ; surgery ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pheochromocytoma ; blood supply ; diagnostic imaging ; surgery ; Radiographic Image Enhancement ; Retroperitoneal Neoplasms ; blood supply ; diagnostic imaging ; surgery ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Young Adult