ABSTRACT
Composite pheochromocytoma is an extremely rare tumor that comprises a pheochromocytoma and an embryologically related neurogenic tumor, such as ganglioneuroma, ganglioneuroblastoma, neuroblastoma, or peripheral nerve sheath tumor. A 46-year-old male with hypertension, elevated plasma catecholamine levels, and suspected pheochromocytoma presented to the National Defense Medical College Hospital. CT and MRI showed two adjacent masses in the left adrenal gland; one was a 6 cm cephalic lesion and the other was a 1.5 cm caudal lesion. Only the 1.5 cm caudal mass showed uptake on 123I-metaiodobenzylguanisine single photon emission CT/CT. Pheochromocytoma was suspected and a left adrenalectomy was performed. Pathology confirmed that the 6 cm mass was a ganglioneuroma and the 1.5 cm mass a pheochromocytoma, with cellular intermingling at their border. The two masses were diagnosed as a composite pheochromocytoma-ganglioneuroma. This is the first report in which the two components of a composite pheochromocytoma can be clearly distinguished in the pre-operative images. If a patient with clinically suspected pheochromocytoma has different components from a typical pheochromocytoma, composite pheochromocytoma should be considered.
ABSTRACT
OBJECTIVES: To determine whether everyday life activities are affected by general cognitive impairment or tool using disabilities in Alzheimer disease (AD) and vascular dementia (VaD). METHODS: Thirty AD the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and 30 VaD the state of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) patients and 10 normal controls (NC) were studied. Everyday activities in the community were assessed with the Social Activities Questionnaire (SAQ), and tool uses were evaluated with the single-tool and the multiple-tool sequence tasks. RESULTS: The SAQ scores of the AD and VaD groups were significantly lower than that of the NC group. For the single tool tasks, the AD and VaD groups exhibited lower scores than the NC group. The sequence score of the VaD group was lower than that of the AD group. The multiple regression analysis disclosed that the SAQ of the AD group was explained by the Mini-Mental State Examination and sequence scores. However, that of the VaD group was mainly explained by the sequence scores. CONCLUSIONS: Disturbances in everyday life activities of AD are associated with general cognitive impairment and sequence disabilities. By contrast, those of VaD may be based only on sequence disabilities.
