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MIBG negative pheochromocytoma.

Nihar Mehta¹, V Paniker, Arpit Shah

¹Department of Medicine, K.J. Somiaya Hospital and Research Centre, Eastern Express Highway, Sion, Mumbai 400 022.

The Journal of the Association of Physicians of India

|September 21, 2010

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A rare left-sided pheochromocytoma case highlights diagnostic challenges. Despite normal urinary tests and MIBG scans, histopathology confirmed the adrenal gland tumor.

Area of Science:

Endocrinology
Oncology
Surgical Pathology

Background:

Pheochromocytoma is a rare neuroendocrine tumor arising from chromaffin cells, typically in the adrenal medulla.
Classical diagnosis involves elevated urinary catecholamines and metabolites, such as vanillylmandelic acid (VMA).
Metaiodobenzylguanidine (MIBG) scintigraphy is a common imaging modality for detecting pheochromocytoma.

Observation:

This case involves a patient with a left-sided pheochromocytoma.
The patient presented with normal 24-hour urinary vanillylmandelic acid (VMA) levels.
A meta-iodobenzylguanidine (MIBG) scan also yielded normal results, failing to detect the tumor.

Findings:

Histopathological examination of the adrenal gland definitively confirmed the presence of pheochromocytoma.

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This case underscores the possibility of pheochromocytoma in the presence of non-diagnostic biochemical and imaging tests.

Diagnostic discrepancies highlight the importance of considering histopathology for definitive diagnosis.

Implications:

Clinicians should maintain a high index of suspicion for pheochromocytoma even with normal conventional diagnostic tests.
Further investigation may be warranted in cases with clinical suspicion despite negative initial workup.
This case contributes to the understanding of atypical pheochromocytoma presentations and diagnostic strategies.