Pheochromocytoma multisystem crisis treated with emergency surgery: a case report and literature review

Background: Pheochromocytoma is a neuroendocrine tumor that predominantly presents with hypertension, palpitations, and tachycardia due to excessive catecholamine excretion. Although pheochromocytoma multisystem crisis (PMC) is relatively rare, urologists and clinicians should focus on early diagnosis as delay in initiating the appropriate treatment can lead to mortality Case presentation: A 70-year-old man developed ileus after a few days of medication for hypertension. Computed tomography incidentally revealed a left adrenal mass. This finding together with his clinical course was compatible with pheochromocytoma. An α-blocker was administered immediately, and his blood pressure was well controlled. However, his general condition and laboratory data deteriorated rapidly, and the patient was diagnosed with PMC with lethal status. Thus, emergency adrenalectomy was performed without confirmation of catecholamine levels. From the resected specimen, his tumor was judged as pheochromocytoma. On immunohistochemical analysis, the proliferation index evaluated by Ki-67 staining was 9.7 %. This case report was approved by the Human Ethics Review Committee of the Nagasaki University Hospital. Conclusion: The present case of PMC was successfully treated with emergency surgery. The benign pheochromocytoma also presented with high cell proliferation potential, which may be a cause of the extreme aggressiveness of PMC

Neoplasms of the genitourinary system

Nephroblastoma or Wilms’ tumor (WT) is the most common renal neoplasm in children accounting for 90 % of pediatric renal tumors (Pastore et al. 2006). It is a tumor with a good prognosis and with well-established treatment strategies. Other rare malignant renal tumors, such as clear cell sarcoma and rhabdoid tumor of the kidney, have a poor prognosis despite aggressive treatment. Renal cell carcinoma occurs in older children, while mesoblastic nephroma is the most frequent renal tumor in the neonate. Hematological malignancies, the most frequent neoplasms in children, may also involve the kidney, most often as part of a multi-organ involvement. Renal infections and malformations are much more common in children than renal tumors and may show a pseudotumoral pattern mimicking a renal tumor. In all cases, close collaboration among radiologists, pediatricians, and pathologists is essential so as to avoid diagnostic pitfalls due to atypical presentations

Genitourinary Pathology (Including Adrenal Gland)

Our aims in constructing the Genitourinary Pathology chapter are to describe neoplasms of the adrenal gland, urothelial tract, kidney, penis, prostate, and testis in a manner that is both useful for the practicing surgical pathologist and that may be used as a reference for all students of urologic pathology. Whereas the text and figures describe the salient morphologic, immunohistochemical, and molecular attributes for each tumor type and encompass the latest classification schemes, the narrative integrates the clinical and pathological findings that are commonly encountered during surgical pathology sign-out of these cases. Accordingly, it is our hope that this chapter will serve as a guide for both general and subspecialized pathologists in contemporary practice