title: Composite pheochromocytoma masquerading as solid-pseudopapillary neoplasm of pancreas.
abstract: Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation.
authors.affiliation: Geetanjali Gupta, Ravindra Kumar Saran, Department of Pathology, Academic Block, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Gupta
authors.affiliation: Geetanjali Gupta, Ravindra Kumar Saran, Department of Pathology, Academic Block, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Saran
authors.affiliation: Geetanjali Gupta, Ravindra Kumar Saran, Department of Pathology, Academic Block, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Satyajit
authors.initials: S
authors.lastname: Godhi
authors.affiliation: Geetanjali Gupta, Ravindra Kumar Saran, Department of Pathology, Academic Block, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: Geetanjali Gupta, Ravindra Kumar Saran, Department of Pathology, Academic Block, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.affiliation: Geetanjali Gupta, Ravindra Kumar Saran, Department of Pathology, Academic Block, GB Pant Hospital, New Delhi 110002, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
keywords: Adrenal; Ganglioneuroma; Pheochromocytoma