2003 Volume 42 Issue 4 Pages 310-313
Background: Metastatic pheochromocytoma of Douglas'pouch is extremely rare.
Case: A 48-year-old woman suffering from hypertension was found in laboratory data to have abnormally elevated catecholamines in both serum and urine 11 years after adrenal pheochromocytoma was resected.
A metastatic tumor of the liver necessitated partial liver resection. Catecholamines in the blood and urine remained high after tumor resection metastatic.
MRI and CT showed a solid mass in Douglas' pouch. In imprint cytology, tumor cells appeared as cohesive clusters. Cells had abundant cytoplasm often containing fine brown granules found in Papanicolaou staining. Nuclei varied in size and were hyperchromatic. Immunohistochemically, tumor cells showed positive reactivity for chromogranin A, synaptophysin, and NSE. The histological diagnosis was malignant pheochromocytoma.
Conclusion: We reported rare metastatic pheochromocytoma in Douglas' pouch 11 years after primary surgery. It is difficult to distinguish between benign and malignant pheochromocytoma based on cytology alone.
