RESUMO
Objetivos: Describir la presentación de un caso clínico de feocromocitoma gigante abscedado benigno debido a su baja frecuencia clínica. Caso clínico: Paciente masculino de 53 años, con enfermedad actual desde agosto/2013 caracterizada por hiporexia, astenia, dolor en hipocondrio derecho, concomitantemente fiebre en 39°C y pérdida de peso de 12 Kg en 4 meses, siendo referido a este centro. Durante su hospitalización presenta cifras tensionales elevadas y palpitaciones. Se realiza ecosonograma abdominal en 2 oportunidades con hallazgos de lesión ocupante de espacio (LOE) en segmentos hepáticos V y VI y lesión parenquimatosa renal derecha grado II. Se realiza TAC abdomino-pélvica con doble contraste donde se evidencia LOE suprarrenal derecho de aspecto neoproliferativo; se solicitan catecolaminas en orina de 24 horas que reportaron elevadas. Se inicia α y β bloqueo con doxazosin y propranolol. Posteriormente se realiza intervención quirúrgica: adrenalectomía derecha con vaciamiento ganglionar y nefrectomía derecha. Macroscópicamente se observó tumor adrenal de 25 cm de diámetro, con contenido purulento fétido en su interior, cuyo cultivo reportó Salmonella sp. La biopsia concluyó en feocromocitoma quístico abscedado con ausencia de hallazgos sugestivos de malignidad. Conclusión: El feocromocitoma es un tumor neuroendocrino con una baja prevalencia, la mayoría son menores de 6 cm, existiendo pocos reportes de casos de feocromocitomas mayores de 20 cm y de lesiones abscedadas, ambas comúnmente asociadas a malignidad. El diagnóstico definitivo es histológico. El tratamiento es la resección quirúrgica.
Objectives: To describe a case of a giant benign abscessed pheochromocytoma due to its low incidence. Clinical case: A fifty-three year old male patient, with current illness since august/2013, characterized by hyporexia, astenia, abdominal pain on right hypochondrium and 39°C fever with 12 kg weight loss in a 4 month period, was referred to this medical center. During hospital stay the patient presents elevated blood pressure and palpitations. An abdominal US is performed twice with the following findings: space-occupying lesion (SOL) on liver segments V and VI and a grade II right renal parenchymal lesion. A double contrast CT-Scan of the abdomen and pelvis is performed and reports a neo-proliferative right suprarenal mass. The 24-hour urinary catecholamine test result was high. α and β blocking with doxazosin and propranolol was initiated. Soon after he was operated: right adrenalectomy with lymph node resection and right nephrectomy. Grossly an adrenal tumor of 25 cm diameter is observed, with fetid, purulent inside content. Culture of purulent content reported Salmonella sp. Biopsy was concluded as cystic-abscessed pheochromocytoma with no suggestive findings of malignancy. Conclusion: Pheochromocytoma is a low prevalence neuroendocrine tumor. Most are less than 6cms, with few case reports of pheochromocytomas more than 20 cm and very few of abscessed lesions, both commonly associated with malignancy. The definitive diagnosis is histological. The treatment is surgical resection.
RESUMO
Cysts of the adrenal glands are uncommon and present difficult problems in differential diagnosis. In autopsy studies, the incidence of adrenal cysts is ranges from 0.064% to 0.18%. Recently, we have experienced a 22-year-old female patient with spontaneous hemorrhagic pseudocyst of adrenal gland without known cause, presenting symptoms of nausea, epigastric discomfort and intermittent pain of right upper abdomen. In clinical presentation, abdominal ultrasonogram and computerized tomogram suggest cystic degeneration of malignant pheochromocytoma, but screening hormonal evaluation was normal. Selective adrenal venous sampling, adrenal scintigram and pathologic examination were not compatible with the functioning adrenal cortical or medullary adenoma/carcinoma, the mass results in spantaneous hemorrhagic necrosis and cystic degeneratio#n of adrenal gland. The authors reported a case of spontaneous hemorrhagic pseudocyst of adrenal gland, which was successfully resected by laparoscopic excision with reviews of the literatures.