Abstract
A 66-year-old man who had been on hemodialysis due to polycystic kidney presented to a neighboring hospital because of chest pain. Abdominal CT scan showed a left adrenal mass incidentally. He was admitted to our hospital urgently because he developed severe hypertension. Serum catecholamine levels were elevated on admission. A contrast-enhanced CT scan showed an enhanced tumor with central necrosis and I123-MIBG scintiscanning revealed abnormal accumulation in the left adrenal gland. The tumor was diagnosed with pheochromocytoma. Preoperative management, including the use ofα1 blocker and dry weight control (+0.7kg), was carefully designed to prevent severe intra and postoperative cardiovascular complications. We performed combined resection of the tumor and the left kidney to prevent intraoperative rapid rise in blood pressure. The tumor was 20×15 cm in diameter and 1,945g in weight. Immunopathologically, this case was finally diagnosed with pheochromocytoma with a high potential of behaving malignant behaviors based on the Pheochromocytoma of the Adrenal Gland Scoring Scale (6 points) and Ki-67 immunostaining (5%).
