Pictorial Urology

16 Urology Journal    Vol 7    No 1    Winter 2010

giant Cystic Pheochromocytoma

A 53-year-old man presented with a 1-month history of pain and a palpable mass in the left side of 
the abdomen. Physical examination revealed a mass on the left half of the abdomen crossing the 
midline. Laboratory data were unremarkable, except for an upper limit of reference range for urinary 
cathecholamine metabolites. Computed tomography and magnetic resonance imaging revealed a huge 
complex cyst in the left side of the abdominal cavity, extending superiorly to the level of the pancreas 
and caudally to the iliac crest, displacing the kidney downward. The mass was surgically removed en bloc 
through a thoracoabdominal incision. The histopathological examination revealed pheochromocytoma 
of the adrenal gland, weighed 3150 g. While magnetic resonance imaging and metaiodobenzylguanidine 
scintigraphy were negative for metastasis, the patient had a urinary normetanephrine level, slightly upper 
than normal. Giant prominently cystic pheochromocytomas are extremely rare tumors.(1) Patients with 
giant pheochromocytomas may not display typical clinical or laboratory manifestations.(2) Abdominal 
computed tomography and magnetic resonance imaging may not determine the origin of mass.(3) 
Pheochromocytoma should be considered in differential diagnosis of abdominal cysts. The presented 
case is one of the largest reported cystic pheochromocytomas with a benign course and no recurrence or 
complications on follow-up.

Abbas Basiri, Mohammad Hadi Radfar
Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences and Erfan Hospital, Tehran, Iran

E-mail: mhadirad@yahoo.com

REFERENCES
1. Pan Z, Repertinger S, Deng C, Sharma P. A giant cystic pheochromocytoma of the adrenal gland. Endocr Pathol. 

2008;19:133-8.

2. Melegh Z, Rényi-Vámos F, Tanyay Z, Köves I, Orosz Z. giant cystic pheochromocytoma located in the renal hilus. Pathol Res 
Pract. 2002;198:103-6.

3. Antedommenico E, Wascher RA. A case of mistaken identity: giant cystic pheochromocytoma. Curr Surg. 2005;62:193-8.

Urol J. 2010;7:16. 
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