Coexistence of Hepatic Metastasis from Malignant Pheochromocytoma and Hepatocellular carcinoma, A Case Report
Natnicha Houngngam, M.Sc., Parichat Yimnoi, M.Sc., Thiti Snabboon, M.D.
Excellence Center of Diabetes, Hormone and Metabolism,Division of Endocrinology and Metabolism, Department of Medicine,Faculty of Medicine,Chulalongkorn University,King Chulalongkorn Memorial Hospital,Bangkok,Thailand
Background: Some distinct features of imaging study may raise the diagnosis of pheochromocytoma;however, several imaging characteristics can be overlapping with those seen in other hypervascular tumors.
Aim:We report an unusual presentation of malignant pheochromocytoma with liver metastasis coexisting with hepatocellular carcinoma (HCC).Proposed imaging characteristics to differentiate between these tumors were discussed.
Case presentation:A 42-year-old previously healthy man complained about upper abdominal pain for 1 week.Physical examinations were unremarkable except for a non-tender large abdominal mass at his left upper quadrant.Computerized tomography demonstrated a 5-cm liver mass accompanied with an 11-cm left suprarenal mass. The diagnosis of HCC was confirmed with liver biopsy and an elevated a-fetoprotein level. He is also seropositive for hepatitis B infection.Hepatic wedge resection with left adrenalectomy for presumed adrenal metastasis was performed,with a noticeable finding of abruptly rising in blood pressure up to 200/120 mmHg during manipulation of the adrenal mass. Pathological reports of the adrenal mass and the liver nodules of the segment IV and II from the wedge resection were compatible with pheochromocytoma. Additional findings from 131-Iodine-metaiodobenzyguanidine (131I-MIBG) scintigraphy and hormonal studies confirmed the coexisting tumors of HCC and malignant pheochromocytoma with liver metastasis. Serial courses of TACE for treatment of HCC and malignant pheochromocytoma and systemic chemotherapy were given with initial clinical response. Unfortunately,the patient has died from hepatic failure at the 18-month follow-up period.
Conclusion:We report an unusual case of co-existence of liver masses from HCC and malignant pheochromocytoma.The clinicians should be aware of this condition to prevent catastrophic event from pheochromocytoma crisis,especially in the endemic areas of HCC.