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Verma R, Hage N, Gude G. Management dilemmas of tracheal paraganglioma: a case report and review of literature. Ann R Coll Surg Engl 2022; 104:e202-e207. [PMID: 35196162 PMCID: PMC9246544 DOI: 10.1308/rcsann.2021.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Paragangliomas of the trachea are rare neoplasms and can present to the clinician with acute airway problems. These neoplasms sometimes are misdiagnosed by general practitioners as asthmatic exacerbation. We present the case of a 66-year-old woman who presented to us with a history of dyspnoea at rest in the supine position and on exertion and a productive cough. This was diagnosed as bronchial asthma and she was treated with corticosteroid inhalers for four months by her GP. She was subsequently evaluated by computed tomography of the neck and thorax, which revealed an intratracheal enhancing lesion measuring around 11 mm in the lower cervical trachea. Fibreoptic bronchoscopy showed a mass lesion at the level of mid trachea. A low tracheostomy was followed by telescopic examination and the mass was resected using coablation. Histology of the mass was reported as paraganglioma. Difficulties encountered and literature review of various management options are presented in this report.
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Affiliation(s)
- R Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Hage
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G Gude
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Thoracic Manifestations of Genitourinary Neoplasms and Treatment-related Complications. J Thorac Imaging 2019; 34:W36-W48. [PMID: 31009398 DOI: 10.1097/rti.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Genitourinary (GU) malignancies are a diverse group of common and uncommon neoplasms that may be associated with significant mortality. Metastases from GU neoplasms are frequently encountered in the chest, and virtually all thoracic structures can be involved. Although the most common imaging manifestations include hematogenous dissemination manifesting with peripheral predominant bilateral pulmonary nodules and lymphatic metastases manifesting with mediastinal and hilar lymphadenopathy, some GU malignancies exhibit unique features. We review the general patterns, pathways, and thoracic imaging features of renal, adrenal, urothelial, prostatic, and testicular metastatic neoplasms, as well as provide a discussion of treatment-related complications that might manifest in the chest. Detailed reporting of these patterns will allow the imager to assist the referring clinicians and surgeons in accurate determination of the stage, prognosis, and treatment options available for the patient. Awareness of specific treatment-related complications further allows the imager to enhance patient safety through accurate and timely reporting of potentially life-threatening consequences of therapies.
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3
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Yang M, Ding H, Cai M, He YA, Cai Y, Zeng Y, Tian BL. Pheochromocytoma of the pancreas: A report of three cases and a literature review. Oncol Lett 2016; 12:959-962. [PMID: 27446377 DOI: 10.3892/ol.2016.4721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/11/2015] [Indexed: 02/05/2023] Open
Abstract
Pheochromocytoma is primarily derived from the adrenal medulla. The majority of extra-adrenal pheochromocytoma cases occur in the superior para-aortic region and para-adrenal area. However, pheochromocytoma originating from the pancreas is rare. The present study reports the cases of three patients who had no history of hypertension but were post-operatively diagnosed with pheochromocytoma located in the pancreas. Of the three patients, two were admitted to hospital due to abdominal pain, and imaging examinations revealed a soft-tissue lesion in the head of pancreas. Local resection of the pancreatic tumor was successfully performed and a diagnosis of pheochromocytoma derived from the pancreas was subsequently made by pathologists. The third patient was admitted to hospital for surgical treatment due to the identification of a continuously growing lesion in the tail of pancreas during physical examinations. Distal resection of the pancreas was stopped during surgery when the patient's blood pressure and heart rate suddenly increased to 180/110 mmHg and 140 beats/min, respectively. Due to a marked rise in noradrenaline and adrenaline levels in the blood subsequent to surgery, the patient was diagnosed with pancreatic pheochromocytoma. The present study additionally reviewed the associated literature concerning pheochromocytoma in order to improve the understanding of this rare clinical phenomenon. The aim of the present study is to highlight to surgeons that although patients may not present with typical clinical manifestations due to the non-functional status of the tumor, undiagnosed pheochromocytoma of the pancreas should be considered when surgeons observe an unexpected hypertensive crisis during pancreatic tumor surgery.
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Affiliation(s)
- Min Yang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hui Ding
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Min Cai
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Yan-An He
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Yu Cai
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Yong Zeng
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Bo-Le Tian
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
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4
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Cruz JF, Iglésias L, Monteiro M, Santos MJ, Pimentel T, Silva RP. Thoracic paraganglioma diagnosed in a patient with pulmonary tuberculosis--case report. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:279-81. [PMID: 24975298 DOI: 10.1016/j.rppneu.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/10/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- J F Cruz
- Serviço de Pneumologia, Hospital de Braga, Portugal.
| | - L Iglésias
- Serviço de Pneumologia, Hospital de Braga, Portugal
| | - M Monteiro
- Serviço de Medicina Interna, Hospital de Braga, Portugal
| | - M J Santos
- Serviço de Endocrinologia, Hospital de Braga, Portugal
| | - T Pimentel
- Serviço de Medicina Interna, Hospital de Braga, Portugal
| | - R P Silva
- Serviço de Anatomia Patológica, Hospital de São João, Porto, Portugal
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5
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Kim EY, Kim TS, Han J, Kim H, Choi YS. Histologically benign but clinically malignant neoplasms in the thorax: CT-pathological overview. Clin Radiol 2012; 67:1115-23. [PMID: 22608250 DOI: 10.1016/j.crad.2012.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/02/2012] [Accepted: 03/14/2012] [Indexed: 11/26/2022]
Abstract
The purpose of this article is to review the computed tomography (CT) and histopathological features of uncommon primary neoplasms of the thorax that can manifest clinically malignant features (multiplicity of pulmonary nodules, an invasive nature, and metastases or recurrence after surgery) with little evidence of histological malignancy.
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Affiliation(s)
- E Y Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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6
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Ceresa F, Sansone F, Rinaldi M, Patanè F. Left atrial paraganglioma: diagnosis and surgical management. Interact Cardiovasc Thorac Surg 2010; 10:1047-8. [DOI: 10.1510/icvts.2009.231043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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7
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Soteras Roura C, Bustos García de Castro A, Cabeza Martínez B, Ferreirós Domínguez J. [Mediastinal paragangliomas: a report of 2 cases]. RADIOLOGIA 2009; 51:420-3. [PMID: 19298985 DOI: 10.1016/j.rx.2008.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
Abstract
Paragangliomas are neuroendocrine tumors derived from chromaffin cells of the extraadrenal sympathetic system; mediastinal paragangliomas are rare. We illustrate and describe the imaging findings in two cases of mediastinal paraganglioma, one nonfunctional aorticopulmonary paraganglioma and one locally aggressive functional aorticosympathetic paraganglioma first observed as a mediastinal mass on chest plain-film radiographs.
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Affiliation(s)
- C Soteras Roura
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain.
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Ghayee HK, Havekes B, Corssmit EPM, Eisenhofer G, Hammes SR, Ahmad Z, Tessnow A, Lazúrová I, Adams KT, Fojo AT, Pacak K, Auchus RJ. Mediastinal paragangliomas: association with mutations in the succinate dehydrogenase genes and aggressive behavior. Endocr Relat Cancer 2009; 16:291-9. [PMID: 19075037 PMCID: PMC4718401 DOI: 10.1677/erc-08-0214] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extra-adrenal pheochromocytomas, otherwise known as paragangliomas (PGLs), account for about 20% of catecholamine-producing tumors. Catecholamine excess and mutations in the genes encoding succinate dehydrogenase subunits (SDHx) are frequently found in patients with PGLs. Only 2% of PGLs are found in the mediastinum, and little is known about genetic alterations in patients with mediastinal PGLs, catecholamine production by these tumors, or their clinical behavior. We hypothesized that most mediastinal PGLs are associated with germ line SDHx mutations, norepinephrine and/or dopamine excess, and aggressive behavior. The objective of this study was to characterize genetic, biochemical, and clinical data in a series of ten patients with mediastinal PGLs. All ten primary mediastinal PGL patients had germ line SDHx mutations, six in SDHB, and four in SDHD genes. Chest or back pain were the most common presenting symptoms (five patients), and catecholamines and/or their metabolites were elevated in seven patients. Additional tumors included head and neck PGLs in four patients, pheochromocytoma in one patient, and bladder PGL in another. Metastatic disease was documented in six patients (60%), and a concurrent abdominal mass was found in one patient. We conclude that mediastinal PGLs are strongly associated with SDHB and SDHD gene mutations, noradrenergic phenotype, and aggressive behavior. The present data suggest that all patients with mediastinal PGLs should be screened for SDHx gene mutations, regardless of age.
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Affiliation(s)
- Hans K Ghayee
- Department of Internal Medicine, University of Texas, Dallas, Texas 75390-8857, USA
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Ota K, Satoh H, Lin SY, Fujita J, Ohara G, Kurishima K, Hizawa N. Endobronchial metastasis from adrenocortical carcinoma. Intern Med 2009; 48:1161-4. [PMID: 19571451 DOI: 10.2169/internalmedicine.48.2113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lung parenchymal metastases are common manifestations; however, endobronchial metastasis is rare. We present herein a case of endobronchial metastasis from adrenocortical carcinoma. In the English language literature, this is the first case with such rare metastasis from adrenocortical carcinoma diagnosed antemortem. Although very rare, physicians should keep in mind the possibility of endobronchial metastasis in patients with a history of extrapulmonary malignancy including adrenocortical carcinoma.
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Affiliation(s)
- Kyoko Ota
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba
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10
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Kim KN, Lee KN, Roh MS, Choi PJ, Yang DK. Pulmonary paraganglioma manifesting as an endobronchial mass. Korean J Radiol 2008; 9:87-90. [PMID: 18253082 PMCID: PMC2627182 DOI: 10.3348/kjr.2008.9.1.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thoracic paragangliomas comprise only 1-2% of all paragangliomas, including the adrenal pheochromocytomas, and these tumors are mostly found in the mediastinal compartments (1). To the best of our knowledge, there is only one case report in the pathology literature of endobronchial involvement by a primary pulmonary paraganglioma (2). We report here on the CT and bronchoscopic findings of a case of pathologically proven endobronchial paraganglioma in a 37-year-old woman. In our case, bronchoscopy and CT demonstrated an endobronchial hypervascular mass, which indicated the presence of carcinoid or hypervascular metastasis based on the known incidence of such tumors.
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Affiliation(s)
- Ki Nam Kim
- Department of Radiology, College of Medicine, Dong-A University, Seo-Gu, Pusan, Korea
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11
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Braham E, Smati B, Ayadi-Kaddour A, Ismaïl O, Jrad-Hannachi S, El Mezni F. [An unusual pulmonary tumor]. Ann Pathol 2008; 28:54-6. [PMID: 18538718 DOI: 10.1016/j.annpat.2007.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Emna Braham
- Service d'anatomie et de cytologie pathologiques, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie.
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12
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Alamán Orbañanos B, Negrete Calderón N, Martín-Romo Capilla J, Becerra Cayetano A. [Anesthetic management in a case of recurrent mediastinal paraganglioma]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:194-196. [PMID: 18402000 DOI: 10.1016/s0034-9356(08)70546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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13
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Madani R, Al-Hashmi M, Bliss R, Lennard TWJ. Ectopic pheochromocytoma: does the rule of tens apply? World J Surg 2007; 31:849-54. [PMID: 17372668 DOI: 10.1007/s00268-006-0608-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The rule of "tens" is often stated to reflect the distribution and histology of pheochromocytomas, with 10% being bilateral, 10%; ectopic in origin, and 10%; malignant. The objective of this study was to review the ectopic pheochromocytomas in a tertiary endocrine center and to establish whether the rule of tens holds true. METHODS Retrospective data were collected on all adrenalectomies and ectopic pheochromocytoma resections performed between 1993 and 2005 at our institution. RESULTS In total, 77 patients had pheochromocytomas: 75%; (58/77) adrenal and 25%; (19/77) ectopic. Of the adrenal pheochromocytomas, 10%; (6/58) were bilateral. The anatomic locations of the ectopic pheochromocytomas were as follows: 26%; (5/19) adjacent to the adrenals, 53%; (10/19) in the organ of Zuckerkandl, 11%; (2/19) in the bladder, 5%; (1/19) in the mediastinum, and 5%;(1/19) in the neck. CONCLUSIONS Our series demonstrates an incidence of 10%; for bilateral pheochromocytoma, which is similar to that in the published reports. However, 25%; of the pheochromocytomas were ectopic. Zuckerkandl pheochromocytomas were the most common among the ectopic lesions. Rarely, these tumors present outside the abdominal cavity.
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Affiliation(s)
- R Madani
- Department of Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK
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14
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Young WF. Secondary Hypertension: Pheochromocytoma. Hypertension 2007. [DOI: 10.1016/b978-1-4160-3053-9.50016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Telera S, Carosi M, Cerasoli V, Facciolo F, Occhipinti E, Vidiri A, Pompili A. Hemothorax presenting as a primitive thoracic paraganglioma. J Neurosurg Spine 2006; 4:515. [PMID: 16776367 DOI: 10.3171/spi.2006.4.6.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stefano Telera
- Divisione di Neurochirurgia, Divisione di Chirurgia Toracica, Servizio di Radiologia e Diagnostica per Immagini, e Servizio di Anatomia Patologica, Istituto Nazionale Tumori Regina Elena, Roma, Italia.
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Akoglu S, Uçan ES, Celik G, Sener G, Sevinç C, Kilinç O, Itil O. Endobronchial metastases from extrathoracic malignancies. Clin Exp Metastasis 2006; 22:587-91. [PMID: 16475029 DOI: 10.1007/s10585-005-5787-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 12/09/2005] [Indexed: 12/19/2022]
Abstract
Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient.
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Affiliation(s)
- Sebahat Akoglu
- Department of Pulmonary Diseases, School of Medicine, Mustafa Kemal University, Hatay, Turkey.
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Bourvis N, Fartoukh M, Christin-Maitre S, François T, Parrot A, Mayaud C. [Intra-alveolar hemorrhage revealing pheochromocytoma]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62:43-8. [PMID: 16604041 DOI: 10.1016/s0761-8417(06)75413-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We report a case of pheochromocytoma revealed by alveolar hemorrhage in a 51-year-old woman. Pheochromocytomas are rare tumors deriving from the chromaffin tissue, and which clinical manifestations are highly variable, mostly unspecific, and very rarely concern the lung. Therefore, the diagnosis is often missed or delayed. However, without correct diagnosis and subsequently adapted treatment, the disease may be fatal. Thus, clinicians should be aware of the possible diagnosis of pheochromocytoma in patients presenting hemoptysis of an unknown origin.
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Affiliation(s)
- N Bourvis
- Service de Pneumologie, Hôpital Tenon, 4, rue de la Chine, 75970 Paris Cedex 20
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18
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Delgado JA, Murali G. PARAGANGLIOMA: A CASE OF PULMONARY NODULES. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.449s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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19
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Affiliation(s)
- Thierry Jacob
- Hôpital d'Instruction des Armées Sainte Anne, Toulon Naval, France
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20
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Fernández R, García Septiem J, Limones M, Camarero E, Dancausa A, Dotor De Lama A. Un caso de paraganglioma del arco aórtico. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71950-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Feocromocitoma torácico: presentación de un caso. HIPERTENSION Y RIESGO VASCULAR 2002. [DOI: 10.1016/s1889-1837(02)71315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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