Malignant Pheochromcytoma Presenting as a Huge Abdominal Mass in the Third Trimester of Pregnancy, a Case Report

Case Report

J Endocr Disord. 2020; 6(3): 1042.

Malignant Pheochromcytoma Presenting as a Huge Abdominal Mass in the Third Trimester of Pregnancy, a Case Report

Moslemi MK¹*, Nazer LSH¹ and Ghoddoosi M²

¹Department of Urology, Qom University of Medical Sciences, Iran

²Department of Pathology, Qom University of Medical Sciences, Iran

*Corresponding author: Mohammad Kazem Moslemi, Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran

Received: December 01, 2020; Accepted: December 23, 2020; Published: December 30, 2020


Introduction: Pheochromocytoma is a metabolically active tumor, which originates from the adrenal medulla chromaffin cells [1]. Five-year survival rate for the malignant pheochromocytoma is 40% [2]. Ten percent of all cases of pheochromocytoma are malignant which involves lymph nodes, liver, and lungs as the most common sites of metastasis [3]. Occurrence of pheochromocytoma during pregnancy is rare, and it is a high risk disease for the mother and fetus. Due to the variable clinical presentation, it needs a high rate of suspicion for its proper detection and treatment. Herein we present a huge right sided abdominal pheochromocytoma which was detected in the third trimester of pregnancy.

Case Presentation: The patient is a 27-year-old woman presented with a huge right sided pheochromocytoma that was found in the third trimester of pregnancy. Three months after an elective caesarian section, the tumor was eradicated completely and the patient’s condition was improved significantly in short term. Persistence of the hypertension and follow up imaging revealed recurrence of the tumor in the primary surgical bed that necessitated the reoperations and palliative chemotherapy 3 years after the primary surgery.

Discussion: Pheochromocytoma is a catecholamine-producing tumor that occurs in in one or both adrenal glands (85%) or involves the sympathetic ganglia (15%) [4]. It is one of the etiologies of hypertension with the prevalence of 0.1-0.6% [5]. The occurrence of pheochromcytoma in pregnancy is very rare with the rate of one in 54000 pregnancies [6,7] or frequency of 0.002% [8]. Malignant pheochromocytoma is radiologically and histologically similar to its benign counterparts [1].

Conclusion: In the case of appropriate follow up, 5 years survival is possible in operated pheochromocytoma even in the malignant and recurrent form of it. However, based on the literature data, this is the first reported case of postpartum malignant pheochromocytoma reported from the Iran.

Keywords: Hypertension; Pregnancy; Pheochromocytoma

Case Presentation

A previously well 27-year-old multiparous Afghanian refugee woman presented with a new onset hypertension and hyperglycemia during the third trimester of her pregnancy. The patient also complained of weight loss, anorexia and headache. She was referred to an obstetric center for management of her presumed preeclampsia but further investigations revealed nothing in favor of this disease. The patient remained hypertensive despite the hypertensive therapy. Considering huge right sided heterogenous mass, which was found in abdominopelvic ultrasonography (187*95*82 mm) and was expanding from liver to the pelvis, high suspicion of adrenal tumor was raised. Also high levels of catecholamine metabolites (metanephrine and Normetanephrine) were detected in the blood and 24 hour urine sample, which confirmed the probable diagnosis. An elective cesarean section was performed after a normal course of pregnancy and a healthy term baby was delivered. After several weeks the patient was admitted to the best equipped hospital of the city for resection of the tumor. Contrast enhanced abdominopelvic CT scan revealed a huge right sided retroperitoneal tumor extending from the sub hepatic area till the pelvic cavity (Figure 1).

Citation: Moslemi MK, Nazer LSH and Ghoddoosi M. Malignant Pheochromcytoma Presenting as a Huge Abdominal Mass in the Third Trimester of Pregnancy, a Case Report. J Endocr Disord. 2020; 6(3): 1042.