Biopsy of pheochromocytomas and paragangliomas: Potential for disaster

Vanderveen, Kimberly A.; Thompson, Scott M.; Callstrom, Matthew R.; Young, William F.; Grant, Clive S.; Farley, David R.; Richards, Melanie L.; Thompson, Geoffrey B.

doi:10.1016/j.surg.2009.09.013

Cited by 129 publications

(82 citation statements)

References 19 publications

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“…Therefore, one would opt for coupling the anatomical imaging of MRI to functional imaging with 123 I-metaiodobenzylguanidine scanning, but because this small molecule probably crosses the placenta, radiation exposure precludes the use of this imaging modality in pregnant women (40). Finally, other diagnostic procedures like presurgical tumor biopsy are contraindicated when one considers a pheochromocytoma because of the potential serious adverse events (41).…”

Section: How To Localize the Tumor During Pregnancy?mentioning

confidence: 99%

ENDOCRINE DISORDERS IN PREGNANCY: Pheochromocytoma and pregnancy: a deceptive connection

Lenders¹

2012

European Journal of Endocrinology

134

139

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A pheochromocytoma in a pregnant patient is one of the most threatening medical conditions for mother, fetus, and physician. Although extraordinarily rare with a frequency of 0.002% of all pregnancies, this tumor is notorious for its devastating consequences. As in non-pregnant patients, the signs and symptoms are quite variable but not specific, with hypertension being one of the most prominent signs. Confusion with the much more prevalent forms of pregnancy-related hypertension is the main cause of overlooking the diagnosis. If undiagnosed, maternal and fetal mortality is around 50%. Conversely, early detection and proper treatment during pregnancy decrease the maternal and fetal mortality to !5 and 15% respectively. For the biochemical diagnosis, plasma or urinary metanephrines are the tests of first choice since they have a nearly maximal negative predictive value. For reliable localization, only magnetic resonance imaging is suitable, with a sensitivity of more than 90%. When the tumor is diagnosed in the first 24 weeks of gestation, it should be removed by laparoscopic adrenalectomy after 10-14 days of medical preparation with the same drugs as in non-pregnant patients. If the tumor is diagnosed in the third trimester, the patient should be managed until the fetus is viable using the same drug regimen as for regular surgical preparation. Cesarean section with tumor removal in the same session or at a later stage is then preferred since vaginal delivery is possibly associated with higher mortality. Despite all technical diagnostic and therapeutic progress over the last decades, the key factor for further reduction of maternal and fetal mortality is early awareness and recognition of the potential presence of a pheochromocytoma in a pregnant patient with hypertension.

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Section: How To Localize the Tumor During Pregnancy?mentioning

confidence: 99%

ENDOCRINE DISORDERS IN PREGNANCY: Pheochromocytoma and pregnancy: a deceptive connection

Lenders¹

2012

European Journal of Endocrinology

134

139

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“…The literature contains numerous case reports from the 1970s to the 1990s of devastating complications related to adrenal biopsy. [38] The fine-needle aspiration biopsy of a pheochromoytoma may result in hemorrhage, tumor implantation, myocardial infarction, arrhythmia, stroke, hypertensive crisis, and death. [38,39] Therefore, the possibility of pheochromoytoma should always be ruled out through biochemical tests before a fine-needle aspiration biopsy is undertaken.…”

Section: Discussionmentioning

confidence: 99%

“…[38] The fine-needle aspiration biopsy of a pheochromoytoma may result in hemorrhage, tumor implantation, myocardial infarction, arrhythmia, stroke, hypertensive crisis, and death. [38,39] Therefore, the possibility of pheochromoytoma should always be ruled out through biochemical tests before a fine-needle aspiration biopsy is undertaken. Given the strong association between imaging features and pheochromoytoma, some experts advocate treatment with an γ-and β-adrenergic blockade and tumor resection in patients with an imaging phenotype of pheochromoytoma, even when the results of biochemical tests for pheochromoytoma are normal.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls in the diagnosis of pheochromocytoma: A case series and review of the literature

Adaş

Koç

Adaş

et al. 2016

JER

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Background: Pheochromocytomas (PC) are neuroendocrine catecholamine-releasing tumors, which arise from chromaffin cells in the adrenal medulla. The clinical presentation of PC depends mostly on the capacity of chromaffin cells to synthesize and release catecholamines, including noradrenaline, adrenaline, dopamine and others. In this case series, we present the pitfalls in the diagnosis and treatment of pheochromocytoma in which the clinical presentation and results of laboratory, radiologic, and nuclear investigations led to an incorrect diagnosis. Case presentation: From 2002 to 2013, seven patients who were misdiagnosed and had pitfalls during treatment were found among 30 patients with pheochromocytoma. We retrospectively reviewed all the medical records of the patients. The data recorded for these seven patients included general demographic data, medical history, symptoms, imaging and laboratory results, histologic interpretation of biopsy and final pathology, and morbidities or mortalities. Conclusion: Correct diagnosis and management of pheochromocytoma is clinically important because misdiagnosis leads to high morbidity and mortality secondary to hypertensive crisis. The critical interpretation of each diagnostic test, attentive review of functional examinations, anatomic imaging methods, and careful history taking is essential for a correct diagnosis.

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“…3 PCCs are associated with a lower rate of malignancy at less than 10%, as opposed to PGLs, which have a malignancy rate up to 40%. 2 Bladder PGLs are extremely rare, making up less than 0.05% of all bladder tumours, and less than 1% of all PCCs and PGLs. Malignancy rates specific to bladder PGLs are reported between 5 -15%, and are higher in hereditary conditions.…”

Section: 2mentioning

confidence: 99%

Case — Bladder paraganglioma in a pediatric patient

Malhotra

Yan

Tabeshi

et al. 2018

CUAJ

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Initial presentationA 12-year-old boy presented with a two-day history of gross hematuria and vomiting. Further questioning revealed a one-year history of position-induced paroxysmal headaches, polyuria, polydipsia, nocturia, dehydration, and lethargy. He denied any syncopal episodes, palpitations, night sweats, blurry vision, or anxiety attacks. He was noted to have normal pubertal development. An abdominal ultrasound was performed, and showed an 8.1 x 7.5cm bladder mass on the posterior bladder wall with hypervascular components (Figure 1). The patient was brought to the operating theater for cystoscopy, which revealed a large, necrotic mass on the postero-lateral bladder wall. Bladder biopsy was performed. There were significant blood pressure fluctuations during the biopsy. Final pathology reported the mass to be a bladder paraganglioma (PGL).The patient received a two-week course of alpha-adrenergic blockade with Prazosin and Amlodipine for blood pressure control prior to definitive surgery. Echocardiogram did not reveal significant cardiomyopathy. PET/CT scan showed no evidence of metastatic disease, but avid F18-fludeoxyglucose ([F-18]FDG) uptake was noted at the tumor site (Figure 2). ManagementThe patient was brought back to operating theatre for treatment via partial cystectomy. The tumor was located near the right ureteric opening, and a ureteric stent was placed for 6 weeks. Pathology reported the resected PGL had negative surgical margins and no invasion into extravesicular fat. The patient was followed with urine metanephrine and blood pressure measurements every three months for surveillance. Subsequent medical genetics consultation revealed an underlying succinate dehydrogenase B (SDHB) gene mutation. First-degree patient relatives were subsequently investigated for the SDHB mutation.

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Biopsy of pheochromocytomas and paragangliomas: Potential for disaster

Cited by 129 publications

References 19 publications

ENDOCRINE DISORDERS IN PREGNANCY: Pheochromocytoma and pregnancy: a deceptive connection

ENDOCRINE DISORDERS IN PREGNANCY: Pheochromocytoma and pregnancy: a deceptive connection

Pitfalls in the diagnosis of pheochromocytoma: A case series and review of the literature

Case — Bladder paraganglioma in a pediatric patient

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