Endocrinol Metab.  2014 Dec;29(4):584-589. 10.3803/EnM.2014.29.4.584.

Incidentally Detected Inoperable Malignant Pheochromocytoma with Hepatic Metastasis Treated by Transcatheter Arterial Chemoembolization

• Kim JK
• Kim BH
• Baek SM
• Shin DH
• Kim WJ
• Jeon YK
• Kim SS
• Kim IJ

• KMID: 2384259
• DOI: http://doi.org/10.3803/EnM.2014.29.4.584

Abstract

Malignant pheochromocytoma (PCC) is a rare condition. Although the liver is the second most frequent site of metastasis in malignant PCC, no definite treatments have been established. Herein, we report a case of liver metastasis of PCC that was successfully treated by transcatheter arterial chemoembolization (TACE). A 69-year-old man was admitted to the Department of Gastroenterology for evaluation of an incidental hepatic mass in August 2013. He had undergone right adrenalectomy in May 2005 and PCC had been confirmed on the basis of histopathological findings. Liver biopsy was performed, and metastatic PCC was diagnosed. The lesion appeared inoperable because of invasion of the portal vein and metastases in the lymph nodes along the hepatoduodenal ligament. Thus, TACE was performed instead. After TACE, symptoms including dizziness and cold sweating improved, and the patient's serum catecholamine levels decreased. On the basis of this case, we believe that TACE may be a useful treatment for liver metastasis in malignant PCC.

Keyword

Malignant pheochromocytoma; Liver metastasis; Transcatheter arterial chemoembolization

MeSH Terms

Adrenalectomy
Aged
Biopsy
Dizziness
Gastroenterology
Humans
Ligaments
Liver
Lymph Nodes
Neoplasm Metastasis*
Pheochromocytoma*
Portal Vein
Sweat
Sweating

Figure

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  Fig. 1 Abdominal computed tomography (A) and magnetic resonance imaging of the liver (B) at admission showed a ~10 cm mass in the right lobe of the liver that had a high signal intensity on T2-weighted images and early arterial enhancement and delayed washout on dynamic contrast-enhanced images. Also, the hepatic mass had a low signal intensity on the hepatobiliary phase and high cellularity on the diffusion phase (white arrows).

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  Fig. 2 An 131I-metaiodobenzylguanidine scan showed increased uptake in the right adrenal gland bed and adjacent liver parenchyma.

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  Fig. 3 Transcatheter arterial chemoembolization (TACE). (A) The hepatic mass was stained in the celiac angiogram. An emulsion of 10 mL of lipiodol and 50 mg of doxorubicin was injected. (B) The tumor was well lipiodolized, as observed by post-TACE imaging. Abdominal computed tomography scans taken (C) 2 weeks and (D) 7 months after TACE revealed partial lipiodol uptake and necrotic changes in the center of the liver mass. The size of the mass (white arrow) had decreased to 8.3 cm.

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  Fig. 4 Vital signs during the first 6 days after transcatheter arterial chemoembolization (TACE). A hypertensive crisis was observed immediately after TACE. The arrows indicate the time of TACE. DBP, diastolic blood pressure; SBP, systolic blood pressure.

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  Fig. 5 Relative estimates of pre- and post-transcatheter arterial chemoembolization (TACE) serum catecholamine levels. Marked decreases in (A) norepinephrine and (B) normetanephrine levels were observed 2 weeks after TACE. E, serum epinephrine (pg/mL); NE, norepinephrine (pg/mL); M, metanephrine (nmol/L); NM, normetanephrine (nmol/L).

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