title: Primary malignant hepatic pheochromocytoma with negative adrenal scintigraphy.
abstract: A 60-year-old male patient with hypertension was referred to our hospital because of insufficient blood pressure control (190/98 mmHg) and to rule out secondary hypertension. A computed tomography scan revealed no adrenal tumor but a large liver mass (5 x 5 cm), and magnetic resonance imaging showed a high signal intensity lesion on the T2-weighted image. Twenty-four hour urinary excretion of catecholamine metabolites was markedly increased, although a 123I-metaiodobenzyl guanidine (MIBG) scintigram failed to show accumulation in the hepatic mass, and no difference was noted between the catecholamine concentration in the tumor-drainage vein and that obtained from the vein draining from the non-tumor area. Liver biopsy did show features compatible with pheochromocytoma (i.e., chromogranin A-positive cells). Transcatheter arterial embolization of the liver tumor was conducted and resulted in a marked (50%) decrease in the 24-h urine normetanephrine excretion. Several metastatic foci were noted in the spinal bone and transcatheter arterial embolization (TAE) was also conducted with successful results. Thus, we experienced a case of primary malignant hepatic pheochromocytoma with negative 123I-MIBG scanning.
authors.affiliation: Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Homma
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayashi
authors.forename: Shu
authors.initials: S
authors.lastname: Wakino
authors.forename: Rie
authors.initials: R
authors.lastname: Irie
authors.forename: Makio
authors.initials: M
authors.lastname: Mukai
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kumagai
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Shibata
authors.forename: Takao
authors.initials: T
authors.lastname: Saruta
mesh_terms: D019797:3-Iodobenzylguanidine; D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D001706:Biopsy; D002395:Catecholamines / Q000652:urine; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
chemical_list: D002395:Catecholamines; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine