Biopsy of pheochromocytomas and paragangliomas: potential for disaster.
ABSTRACT Pheochromocytomas and paragangliomas are highly vascular neuroendocrine neoplasms that often secrete catecholamines. Percutaneous biopsy has been associated with life-threatening hemorrhage, hypertensive crisis, capsular disruption with tumor implantation, and death. We sought to determine the outcomes of biopsy in 20 consecutive patients.
We reviewed retrospectively the medical records of patients with biopsied pheochromocytomas and paragangliomas referred to our Endocrine Division for subsequent management between 1995 and 2005. Biopsy complications, operative findings, and outcomes were reviewed.
Twenty patients (14 pheochromocytomas and 6 paragangliomas) were biopsied percutaneously prior to referral. Mean tumor diameter was 6.4 cm (range, 1-15). Pre-biopsy biochemical testing was not performed in 90% of patients, and was negative in the remainder. Fourteen patients (70%) developed a biopsy-related complication, including: increased difficulty of the definitive operation in 7 of 17 (41%) operative cases with 1 patient requiring conversion to an open procedure; severe hypertension (15%); hematoma (30%); incorrect or inadequate biopsy (25%); severe pain (25%); and delay in surgical treatment (15%). Mean follow-up was 58 months, with 4 tumor-related deaths and 2 recurrences.
Biochemical testing prior to biopsy of adrenal or suspicious retroperitoneal masses is critical to exclude a catecholamine-secreting neoplasm because serious complications and increased operative difficulty can result.
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ABSTRACT: Objective: Neurofibromatosis Type-1 (NF1) carries an increased risk of pheochromocytoma. Most experts recommend NF1 patients be screened for pheochromocytoma if hypertension develops. We sought to compare NF1 and non-NF1 patients with pheochromocytoma.Methods: Retrospective analysis of a prospectively collected database of all patients undergoing pheochromocytoma resection by a single surgeon from 2003-2012. Statistical significance was tested with Fisher's exact test for categorical variables and the Wilcoxon rank sum test for continuous variables.Results: Of 56 patients undergoing resection of pheochromocytoma, 6 (11%) had NF1. All 6 (100%) NF1 patients had pheochromocytoma diagnosed incidentally during work-up for another condition, while 28/50 (56%) non-NF1 associated pheochromocytomas were diagnosed incidentally (p=0.071). Hypertension was present in 1 (17%) NF1 patient, and in 37 (74%) of the non-NF1 patients (p=0.011). Tumors were significantly smaller in NF1 compared to non-NF1 patients (median tumor dimension 2.75 cm vs. 5.9 cm, respectively, p=0.014).Conclusions: Although NF1 patients have a well-known increased risk of developing pheochromocytoma, in the current series all NF1 patients referred to the surgeon for adrenalectomy had pheochromocytoma diagnosed incidentally. Nevertheless, NF1 patients had significantly smaller tumors and less hypertension than other patients treated for pheochromocytoma, perhaps due to higher frequency of imaging occasioned by their other neoplasms. The common recommendation to screen for pheochromocytoma when hypertension develops would have failed to spur screening in 83% of these NF1 patients. Routine screening for pheochromocytoma in all NF1 patients may be warranted after evaluating whether this is cost-effective in reducing morbidity and mortality.Endocrine Practice 02/2014; · 2.49 Impact Factor
- Current problems in surgery 04/2014; 51(4):151-87. · 1.42 Impact Factor
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ABSTRACT: Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The utility, sensitivity, and effect on patient outcome of transcutaneous adrenal biopsy (TAB) for single, large, adrenal masses are unclear.European Journal of Endocrinology 06/2014; 170(6):829-35. · 3.69 Impact Factor