Endocrine Abstracts

Introduction: Pheochromocytoma is usually benign neuroendocrine tumor arising from chromaffin cells. Malignant tumors which account for 5–26% mainly metastize to bones, lungs, liver, but very rarely to brain. The coexistence of pheochromocytoma with brain meningioma may hinder the diagnosis.

Aim: The aim of this study is to present the case of a malignant pheochromocytoma female with brain metastases and coexisting meningioma.

Case description: Patient, aged 60, with non-stable hypertension, after adrenalectomy in 2005 because of right adrenal tumor, 38×32×70 mm in size. Histopathologic diagnosis – pheochromocytoma. In September 2006, neurologic abnormalities appeared. CT examination revealed three cerebral tumors. Craniotomy was done and tumors removed. Histopathologic examination revealed two pheochromocytoma metastases in left frontal and parietal cerebral regions and one meningioma in temporal region. Brain radiotherapy was administrated – total dose of 20 Gy. Concentrations of urinary metanephrines and serum chromogranine A were normal. 131-I MIBG scintigram detected no pathologic uptake in the body. In August 2008, abdominal CT examination showed reccurence of disease in the site after right adrenalectomy and focal lesion in the right lung.131-I MIBG scan showed abnormal uptake in the region of right adrenal gland and the head of pancreas. MR examination revealed metastases in the right cerebellar hemisphere and left frontal cerebral lobe. Biochemical tests results were normal. CVD scheme chemotherapy and brain radiotherapy (total dose of 20 Gy) were administrated The patient remains under oncological and endocrinological observation.

Conclusions: 1. Pheochromocytoma is rarely malignant tumor and brain metastases are its atypical localization.

2. Due to unequivocal histolpathologic standards, malignancy is diagnosed by the presence of metastases.

3. Patients treated for pheochromacytoma require constant endocrinological and oncological observation.

4. Pheochromocytoma with coexisting meningioma may impede the diagnosis of brain metastases.