Case Report
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World Journal of Gastrointestinal Surgery. Nov 27, 2013; 5(11): 309-313
Published online Nov 27, 2013. doi: 10.4240/wjgs.v5.i11.309
Malignant pheochromocytoma: Hepatectomy for liver metastases
Tomohide Hori, Kentaro Yamagiwa, Tadataka Hayashi, Shintaro Yagi, Taku Iida, Kentaro Taniguchi, Yoshifumi Kawarada, Shinji Uemoto
Tomohide Hori, Shintaro Yagi, Taku Iida, Shinji Uemoto, Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan
Kentaro Yamagiwa, Kentaro Taniguchi, Yoshifumi Kawarada, First Department of Surgery, Mie University Hospital, Tsu, Mie Prefecture, 514-8507, Japan
Tadataka Hayashi, Second Department of Surgery, Hamamatsu University Hospital, Hamamatsu, Shizuoka, 431-3192, Japan
Author contributions: Kawarada Y proposed the study; Hori T analyzed the data and wrote the initial draft; Uemoto S supervised this report; all the authors contributed to the design and interpretation of the study and to further drafts.
Supported by A grant to Hori T from the Uehara Memorial Foundation, Tokyo 171-0033, Japan, No. 200940051
Correspondence to: Tomohide Hori, MD, PhD, Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto 606-8507, Japan. horit@kuhp.kyoto-u.ac.jp
Telephone: +81-75-7513651 Fax: +81-75-7513106
Received: August 26, 2012
Revised: November 23, 2012
Accepted: December 20, 2012
Published online: November 27, 2013
Abstract

Malignant pheochromocytoma accounts for approximately 10% of pheochromocytoma cases. The main site of distant metastasis is the liver. Hypertensive crisis due to catecholamine oversecretion is potentially fatal. We present a case of malignant pheochromocytoma with multiple liver metastases. A 60-year-old female with repeated hypertensive episodes was diagnosed with malignant pheochromocytoma. She underwent a left adrenalectomy and partial hepatectomy with resection of segment 6. Catecholamine levels remained high after surgery and she received repeated cycles of chemotherapy. Four months after surgery, multiple liver metastases were detected. In spite of ongoing chemotherapy, catecholamine levels eventually became uncontrollable. Serum and urine noradrenaline and vanillylmandelic acid levels increased, but adrenaline and dopamine levels stayed within the normal range. Preoperative liver imaging revealed multiple metastases in all segments except segment 4. Percutaneous transhepatic portal vein embolization (PTPE) of the right and lateral branches of the portal vein was performed. The functional liver volume of segment 4 increased after PTPE. Right hepatectomy, lateral segmentectomy and partial resection of segment 1 were performed 10 mo after the initial surgery. Intraoperative ultrasonography detected two small tumors in segment 4, which were treated with intraoperative microwave coagulation therapy. Noradrenaline levels normalized immediately after the second hepatectomy. As there was increased telomerase activity in the resected specimen, she received adjuvant chemotherapy. She remained in good health for 2 years. However, further metastases eventually occurred and she subsequently died due to a brain hemorrhage. Hepatectomy may be a therapeutic option for reduction of tumor mass in pheochromocytoma with liver metastases.

Keywords: Malignant pheochromocytoma; Liver metastasis; Mass reduction; Percutaneous transhepatic portal vein embolization; Hepatectomy