Diagnosis and treatment of extra-adrenal pheochromocytoma / 中华泌尿外科杂志

ABSTRACT

Objective To highlight the diagnostic and t herapeutic procedures for extra-adrenal pheochromocytoma. Methods Thirty-eight cases of extra-adrenal pheochromocytoma proven patholo gically from 1998 to 2002 were reviewed and studied.Hypertension was observed in 34 cases and intermittent macrohematuria in 4 patients.Another 2 cases were adm itted to hospital with abdomen masses through routinely physical examination.Uri nary VMA,serum and urinary catecholamine were measured in 33 cases.38 cases had B-model ultrasound examination and 34 cases took CT scan.The level of urine VMA elevated in 30 cases(91%) and serum or urinary catecholamine were elevated in 2 8 (85%).The positive rates of localization of B-ultrasound and CT were 92% and 100%,respectively.29 cases took ?-receptor blocker for at least 2 weeks preope ratively.There were 6 cases operated under epidural anesthesia and 32 general an esthesia.Six cases were operated transvesical.10 cases with lumber incision and 19 with abdominal incision.The other 3 cases operated laparoscopically. Results Tumor location,6 cases in bladder wall,7 in renal hilum, 9 in upper pole of kidney,4 in low pole,10 in anterio-lateral to the adrenal gl and,and 2 cases of multifoci.The specimens were from 2 to 9 cm in size.Among 34 cases with hypertension,the blood pressure of 26 patients return to normal and 2 cases were still hypertensive.10 cases were assayed as malignant pheochromocyto ma.There were 9 cases of recurrence or metastases and 5 patients died during fol lowed-up from 13 months to 10 years. Conclusions Urine VMA level is a useful marker to detect extra-adrenal pheochromocytoma and CT sc an is the most reliable in localizing the lesions. 131I-MIBG scintigra phy is of great value for the localization and quantitative for extra-renal phe ochromocytoma with high sensitivity and accuracy.It may be also used as a therap eutic method.Surgical manipulation of the tumor is the best management and metic ulous perioperative management is extremely important.Measuring the level of uri nary catecholamine can monitor the recurrence or metastasis of the tumor.