title: Composite pheochromocytoma-ganglioneuroma: a rare experiment of nature.
abstract: OBJECTIVE
  To present a rare case of composite pheochromocytoma-ganglioneuroma (Pheo-GN) of the adrenal medulla, review the related literature, and discuss the clinical features, pathologic findings, behavior, and management of such tumors.
  
  
  METHODS
  A case report of a patient with composite Pheo-GN of the adrenal gland is presented. Using the online database PUBMED, we searched and analyzed all cases of composite pheochromocytoma reported in the English-language literature during the past 70 years.
  
  
  RESULTS
  On computed tomography, a 61-year-old man was incidentally found to have a 3.8-cm nonadenomatous right adrenal lesion. Adrenalectomy revealed a 5-cm mass consistent with composite Pheo-GN. To date, 45 cases of composite pheochromocytomas have been reported during the past 70 years, 71% of which coexisted with ganglioneuromas. These tumors occurred with approximately equal frequency in male and female patients, the majority of whom were from 40 to 60 years old. Only 14 cases have been reported in the United States. Bilateral tumors were found in 3 cases. The mean size was 4 to 6 cm. Preoperatively, functional evidence was found in 76.3% of all composite pheochromocytomas (and in 67% of Pheo-GN). Only one Pheo-GN was found to have liver metastatic lesions at the time of autopsy; the rest were not aggressive.
  
  
  CONCLUSIONS
  To our knowledge, this is the first literature review describing the characteristics and behavior of all reported cases of composite pheochromocytomas, with an emphasis on those with ganglioneuromas. Composite pheochromocytoma is a rare variant of a relatively uncommon disease diagnosed by pathologists only. Fortunately, the treatment of such an entity remains the same as for any pheochromocytoma.
authors.affiliation: Department of Medicine, Section of Endocrinology, Tulane University, New Orleans, Louisiana 70112, USA. amnakhan@tulane.edu
authors.forename: Amna N
authors.initials: AN
authors.lastname: Khan
authors.forename: Solomon S
authors.initials: SS
authors.lastname: Solomon
authors.forename: Richard Dale
authors.initials: RD
authors.lastname: Childress
mesh_terms: D005729:Ganglioneuroma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000473:pathology