Metastatic pheochromocytoma to liver without elevation of metanephrines and catecholamines.
BACKGROUND
Malignant pheochromocytoma represents 10% of all patients with pheochromocytoma. Of these cases, only 5-9% presents without elevation of metanephrines and catecholamines.


METHODS
A 43-year-old female patient presented with an abdominal tumor. An exploratory laparotomy was performed and the final report was a pheochromocytoma. After ten years, multiple liver lesions were detected and surgical treatment was performed. Pathological evaluation revealed a malignant pheochromocytoma with negative margins after 5 years of follow-up without evidence of disease.


CONCLUSIONS
The recurrence rate of malignant pheochromocytoma is 15-20% at ten years and a 5-year survival rate that ranges from 50% to 80%. The presence of synchronous metastases is rare (10-27%), but have been reported until 20 years later with the most common metastatic sites being the local lymph nodes, bone (50%), liver (50%) and lung (30%). The prognostic factor such as size >6cm, age over 45 years, synchronous metastasis and no tumor excision are related with poor prognosis.


CONCLUSIONS
Surgical treatment offers the best survival rate and the only chance of cure so far and the goal is an R0 resection as in our case. So it should be the treatment of choice.
Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico. Electronic address: javierlopgom@hotmail.com.
Javier
J
López-Gómez
Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Ma Alejandra
MA
Salazar-Álvarez
Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Rodrigo Y
RY
Adame
Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Alejandro
A
Alfaro-Goldaracena
Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Erwin R
ER
Flores-Vazquez
Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Sergio H
SH
Gonzalez-Infante
Surgical Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Alejandro E
AE
Padilla-Rosciano
Surgical Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Seccion XVI, C.P. 14080, Mexico.
Horacio N
HN
López-Basave
M; Metastatic pheochromocytoma; Synchronous metastases; etanephrines - Catecholamines