Laparoscopic Resection of an Extra-adrenal Pheochromocytoma

Abstract

Extra-adrenal pheochromocytomas are of rare occurrence. Since first reported laparoscopic adrenalectomy has become the gold standard in the treatment of adrenal tumors, the feasibility of laparoscopic adrenalectomy in the setting of pheochromocytoma has also been established given a careful preoperative planning. Literature on the laparoscopic treatment of extra-adrenal pheochromocytomas is lacking. We report a hypertensive 54-year-old male patient (body mass index, 26.2) with elevated urinary catecholamines and a 6-cm solid mass under the right renal hilum diagnosed after a magnetic resonance. The patient underwent complete transperitoneal laparoscopic excision of the tumor. Recovery was uneventful and final histopathologic examination showed an extra-adrenal pheochromocytoma. We believe that transperitoneal laparoscopic excision of extra-adrenal pheochromocytoma is a feasible and reproducible technique that allows for complete removal of tumoral tissue with low morbidity, shorter hospital stay, and minimal convalescence.

Retroperitoneoscopic Resection of Primary Paraganglioma: Single-Center Clinical Experience and Literature Review

“…Medians of operative time, blood loss, and postoperative hospital stay were 202.5 minutes (95-545 min), 100 mL (10-1500 mL), and 4 days (1-13 days), respectively. 2,[8][9][10][11][12][13][14][15][16][17][21][22][23][24][25][26]28,31,32,[34][35][36] Four studies described their reasons for conversion to open surgical procedures such as intraoperative bleeding, poor visibility of posterior veins, difficulties in identifying the ureter, and the dense adherence to surrounding structure.s 13,21,34,36 Postoperative complications were only reported by five publications with the transperitoneal laparoscopic approach, which were wound infection, ileus, lymphatic fistula, gluteal hematoma, lymphedema, vena caval bleeding, lymph ascites, as well as pneumonia, 4,12,13,21,22 The overall complication rate was eight of 68 (11.8%), including six (8.8%) Clavien I, one (1.4%) Clavien II, and one (1.8%) Clavien III. Both recurrence and metastasis were not found during 17.5 months (3-108 mos) follow-up in 18 articles.…”

“…Both recurrence and metastasis were not found during 17.5 months (3-108 mos) follow-up in 18 articles. 4,[8][9][10][11][16][17][18]21,22,24,25,[29][30][31][32]34,36 Discussion Approximately 50% of patients with catecholaminesecreting tumors have true paroxysmal hypertension in clinical practice; 35% to 45% have persistent hypertension, and the remaining patients have no hypertension. 37 Hypertension as one of the typical clinical symptoms is the result of catecholamines (epinephrine, norepinephrine, and dopamine) that are secreted by the tumors and released into the systemic circulation.…”

Prenatal diagnosis of an adrenal mature teratoma mimicking a neuroblastoma

“…Teratomas are defined by the presence of cell types from different germ layers and they are classified as mature or immature based on the degree of differentiated tissue. Mature teratomas have above all well-differentiated component, while immature teratomas are composed of at least 10% immature tissue and are at a higher risk for malignant behavior [ 1 ].…”

“…Adrenal teratomas are rare neoplasms and are reported to account for only 1–4% of surgically excised adrenal nodules [ 1 - 3 ].…”

Primary adrenal teratoma: Clinical characteristics and retroperitoneal laparoscopic resection in five adults

“…Primary adrenal teratoma is extremely rare, and only a few individual case studies and small series can be retrieved from the clinical literature (5)(6)(7). To the best of our knowledge, the largest reported series of patients with primary adrenal teratoma described three cases in a study by Lam and Lo (8).…”