Surgical strategies of complicated pheochromocytomas/paragangliomas and literature review

Abstract

Pheochromocytomas (PCC)/paragangliomas (PGL) are catecholamine (CA) -secreting neuroendocrine tumors, which are known as PPGL due to their histological and pathophysiological similarities. In addition to the typical triad of paroxysmal headache, palpitation, and sweating, PPGL may also be accompanied by symptoms and signs involving multiple organs and systems such as the cardiovascular system, digestive system, endocrine system, and nervous system. Currently, surgical resection is the first choice for PPGL. Safe and effective surgical management of complicated PPGL is the goal of clinical work. In this paper, we discuss this hot issue based on complicated PPGL cases, aiming to share our experience of the surgical management strategy of PPGL.

Preoperative 3-dimensional visualization technology-assisted laparoscopic resection of ectopic pheochromocytoma surrounding the renal artery: a case description

“…Preoperative reconstruction image is necessary to provide the surgeon with a 3D perspective and formulate appropriate surgical strategies for ectopic PCC affecting the surrounding tissues and organs. After reviewing articles on adrenal tumor and combining with clinical experience, we recommended 3D reconstruction of adrenal tumor when it is excessively large, has a close relationship with the surrounding organs and blood vessels, or is considered a pheochromocytoma or other hormone-releasing tumor; 3D imaging can help in designing an appropriate approach and avoiding unnecessary tumor extrusion ( 11 , 12 ). In this case study, we used 3D Slicer, a free and open-source software, to visualize and reconstruct the vascular organs surrounding the ectopic pheochromocytoma.…”

A case report on pheochromocytoma mimicking as fulminant myocarditis—a diagnostic challenge

“…Moreover, imaging tools like CT scan or magnetic resonance imaging (MRI) aid in identifying adrenal or extra-adrenal tumors ( 15 , 16 ). The confirmation of a pheochromocytoma diagnosis necessitates initiating alpha-blockade therapy to manage hypertension and prepare the patient for surgical intervention, which is the ultimate treatment strategy for this condition ( 17 ). The significant improvement observed in our patient after initiating alpha-blockade and undergoing adrenalectomy reinforces the efficacy of this therapeutic regimen.…”

Management of Abdominal Paraganglioma: A Single Center’s Experience

“…The diagnostic localization of a PCC/PGL is traditionally attempted only once excess catecholamine has been biochemically ascertained [17,18]. Both computed tomography (CT) scanning and MRI are mainstays for adrenal imaging and are used as the primary tests for localizing catecholamine-secreting tumors.…”

“…Several clinical researchers have reported that lesion detection sensitivity with 68-Ga DOTATOC is higher than with other conventional functional imaging techniques, especially in metastatic and multifocal primary diseases. Its use is recommended in parallel with 18 FDG PET-CT [19,20].…”