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KMID : 0371319730150020083
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Journal of the Korean Surgical Society
1973 Volume.15 No. 2 p.83 ~ p.92
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Pheochromocytoma Associated with Adenocarcinoma of the Stomach
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李泰烈/Lee, Tae Yeul
崔東河/裵洙東/孫寬秀/서주영/Choi, Dong Ha/Pai, Soo Tong/Son, Kwan Soo/Suh, Choo Yung
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Abstract
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A case of the pheochromocytoma arising from the left adrenal gland associated with mucinbus adenocarcinoma of the stomach was treated successfully in this hospital. The patient is a 53 years old housewife who gives history of frequent attack of headache, dizziness, palpitation and blurred vision in the past seven years. A year ago, she felt a mass in her left upper abdomen which grew slowly larger with aggravation of above symptoms.
On examination, the patient appeared pale and emaciated. Blood pressure was 160/110 and pulse 90/min. There was a rounded fist sized smooth surfaced firm and elastic mass palpated at the left hypochondric region of the abdomen. Immediately following the palpation of this mass, patient´s blood pressure rose to 260/170. Upper G.I. Series showed a large extrinsic indentation at the greater curvature of the stomach. There was an irregular shaped ulcer crater at the lesser curvature of the stomach. Regitin test was significant and 24 hour urinary excretion of vanillylmandelic acid was greatly elevated. Laparotomy revealed a large solid reddish brown tumor arising from the left adrenal gland. Right adrenal was normal. There was an ulcerating carcinoma at the lesser curvature of the stomach with enlarged regional Iymphnodes. On manipulation of the tumor mass, the blood pressure rose to 190/160 and this was promptly controlled by intravenous infusion-of regitine solution. Soon after complete removal of the tumor, the systolic pressure dropped to 90 and this was controlled with norepinephrine infusion. Billroth I type subtotal gastrectomy was also carried out. This patient has had uneventful recovery from surgery and was discharged ten days after operation. Blood pressure was stabilized around 125/80 by the time of discharge and urinary excretion of VMA was also normal a few days after operation.
The excised tumor mass was measured 11 by 9 by 7 cm. and weighed 450 gm. LYistopathology was reported as benign Pheochromocytoma arising from the adrenal gland. The lesion in the stomach was reported as mucinous adenocarcinoma with metastasis to the regional lymphnodes.
Association of this condition with neurofibromatosis has been well documented in the literature but as far as we could search in the literature, this is-probably the first reported case of pheochromocytoma associated with carcinoma of the stomach.
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