Background
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.
Methods
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.
Results
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.
Conclusion
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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References
- Pheochromocytoma in Sweden 1958-1981. An analysis of the National Cancer Registry Data.Acta Med Scand. 1986; 220: 225-232
- Prevalence of adrenal incidentaloma in a contemporary computerized tomography series.J Endocrinol Investig. 2006; 29: 298-302
- Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota.Endocrinol Metab Clin North Am. 2000; 29: 159-185
- Swedish Research Council Study Group of Endocrine Abdominal Tumours. Adrenal incidentaloma–experience of a standardized diagnostic programme in the Swedish prospective study.J Intern Med. 2002; 252: 239-246
- Management of the clinically inapparent adrenal mass (“incidentaloma”).Ann Intern Med. 2003; 138: 424-429
- Clinical practice. The incidentally discovered adrenal mass.N Engl J Med. 2007; 356: 601-610
- Sonographically guided fine-needle aspiration biopsy of adrenal masses.AJR Am J Roentgenol. 1984; 143: 1081-1084
- Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies.AJR Am J Roentgenol. 2004; 182: 1033-1037
- Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications.Curr Probl Diagn Radiol. 2003; 32: 3-10
- Metastatic phaeochromocytoma: risks of diagnostic needle puncture and treatment by arterial embolisation.J Hum Hypertens. 2001; 15: 209-211
- Unsuspected pheochromocytoma: risk of blood-pressure alterations during percutaneous adrenal biopsy.Radiology. 1986; 159: 733-735
- Extraadrenal pheochromocytoma: a rare cause of tachycardia and hypertension during percutaneous biopsy.AJR Am J Roentgenol. 2005; 185: 554-555
- Pheochromocytoma manifesting with shock presents a clinical paradox: a case report.CMAJ. 1997; 157: 923-925
- Cystic pheochromocytoma with inadvertent needle biopsy and glucagon administration.Can Assoc Radiol J. 1987; 38: 232-233
- Fine-needle aspiration of catecholamine-producing adrenal masses: a possibly fatal mistake.AJR Am J Roentgenol. 1985; 145: 113-114
- Needle biopsy of incidentally discovered adrenal masses is rarely informative and potentially hazardous.Surgery. 2007; 142: 497-502
- Percutaneous biopsy of adrenal and extra-adrenal retroperitoneal lesions: beware of catecholamine secreting tumours!.Surgeon. 2007; 5: 279-281
- Natural history of a sporadic pheochromocytoma.Endocr Pract. 2008; 14: 391
State-of-the-Science Conference Statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH Consens State Sci Statements. 2002 Feb 4-6;19:1-25. ID:14768652. Available from: http://consensus.nih.gov/2002/2002AdrenalIncidentalomasos021html.htm. [Accessed 28 Feb 2009].
- Diagnosis and treatment of pheochromocytoma in an academic hospital from 1997 to 2007.Am J Med. 2009; 122: 85-95
- Biochemical diagnosis of pheochromocytoma: which test is best?.JAMA. 2002; 287: 1427-1434
- Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results.J Clin Endocrinol Metab. 2003; 88: 2656-2666
Article info
Publication history
Accepted:
September 17,
2009
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
