Endosonographic Imaging of Benign and Malignant Pheochromocytomas

• Published in: The journal of clinical endocrinology and metabolism Vol. 89; no. 4; pp. 1694 - 1697
• Main Authors: Kann, P. H., Wirkus, B., Behr, T., Klose, K.-J., Meyer, S.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-04-2004; Copyright by The Endocrine Society
• Subjects: Adrenal Gland Neoplasms - diagnostic imaging; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Biological and medical sciences; Diagnosis, Differential; Endocrinopathies; Endosonography; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pheochromocytoma - diagnostic imaging; Pheochromocytoma - secondary; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Secretory tumor; Pheochromocytoma; Nutrition; Metabolic diseases; Malignant tumor; Endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2003-031709

Endosonography enables imaging of the adrenal glands, the mediastinum, and the epigastric retroperitoneal area. In this study, the diagnostic power of endosonography regarding the detection and localization of pheochromocytomas and the differentiation between benign and malignant lesions and their metastases and recurrences was investigated. Endosonography was performed using a Pentax FG 32 UA endosonoscope with a longitudinal 7.5-MHz sector array from the esophagus, stomach, and duodenum. A total of 22 pheochromocytomas in 11 patients were studied. All these tumors, recurrences, and metastases were histologically proven except in one single patient where pheochromocytoma had been diagnosed histologically in the past, and actual findings were obvious local recurrence and four metastases. Malignant pheochromocytoma (n = 10) tended to be larger at the time of examination than benign pheochromocytoma (n = 12; P = 0.069). No significant differences between benign and malignant pheochromocytomas regarding echogeneity and echostructure could be detected. However, hyperechoic echogeneity was seen only in benign lesions, which, however, had variable echogeneity. If confirmed by future observations, hyperechoic echogeneity may be considered to be suggestive of a benign nature. In several cases, endosonography detected small lesions that had been missed by routine diagnostic procedures and yielded helpful information for planning surgical strategy. In conclusion, endosonography is considered to be useful in early detection of pheochromocytomas, and in malignant disease of recurrence and metastases.