Thoracic Spinal Cord Compression Caused by Metastatic Pheochromocytoma

Hospital Physician May/June 2009 35 P heochromocytoma is a tumor derived from adrenal medulla chromaffin cells that pro­ duces and secretes catecholamines. It can also present as a paraganglioma of the extra­ adrenal sympathetic and/or parasympathetic nervous system. The incidence of pheochromocytoma is ap­ proximately 1 to 6 cases per million persons.1 At the initial diagnosis of pheochromocytoma, the primary tumor may be either benign or malignant, but it is dif­ ficult to differentiate between benign and malignant tumors prior to metastasis.2 After surgical resection of a presumed benign pheochromocytoma, only 13% of cases recur, again either as a benign or malignant tumor.3 Approximately 10% of all pheochromocyto­ mas are considered malignant.2,4 Presence of distant metastases clinically defines malignancy. The most common sites of metastases are the bones, lungs, liver, and retroperitoneal or mediastinal lymph nodes.2,4–13 This article reports the case of a woman who had pheochromocytoma that metastasized to the thoracic spine and presented with cord compression, necessitat­ ing urgent neurosurgical intervention. A review of the surgical management of patients with metastatic pheo­ chromocytoma is also provided.