A Case of Malignant Pheochromocytoma Detected during Fertility Treatment

We report a case of malignant pheochromocytoma in a 35-year-old Japanese woman during fertility treatment, successfully treated with surgical excision. The patient recovered without any postoperative problems, and plasma catecholamine levels normalized. At present, 18 months after the operation, there are no signs of relapse. 1. Introduction Although the incidence of malignant tumors during fertility treatment with ovulation-inducing drugs has been described in several reports, many authors state that in the short-term, ovulation-induction treatment may not be a risk factor for ovarian cancer. Herein we describe a case of malignant pheochromocytoma detected during fertility treatment. 2. Case Report We evaluated a 35-year-old woman with no medical or family history of endocrine disease. She underwent surgical removal of the benign breast tumor at the age of 22 and underwent a surgical procedure for a uterine myoma at the age of 32. She started visiting the Department of Obstetrics and Gynecology at our hospital for fertility treatment in 2009 (31 years of age). In January 2012, a tumor of 10？cm diameter was identified on the inferior side of the right hepatic lobe via abdominal ultrasound screening. Malignant pheochromocytoma was diagnosed using imaging (CT, MRI) and endocrine testing, and consequently the patient was referred to our department for a surgical procedure. The subjective symptoms were as follows: no headache, no pallor of the face, no palpitations, and a sudden rise in temperature. There was no hypertension. The patients’ characteristics recorded at the time of hospital admission were as follows: height 149.8？cm, weight 57.6？kg, BMI 25.7, blood pressure 110/65, heart rate 75？bpm, and body temperature 36.4°C. The abdominal tumor was not palpable. Biochemical examination of blood showed fractionated plasma catecholamine levels as follows: adrenaline <5？ng/mL (0–100), noradrenaline 809？ng/mL (100–450), and dopamine 8？ng/mL (0–20); thus, only the noradrenaline level was elevated. Fractionated urinary catecholamines were as follows: adrenaline 10？μg/day (1.5–4.3), noradrenaline 568？μg/day (3.4–26.9), and dopamine 685？μg/day (365–961); only the noradrenaline level was elevated. Diagnostic imaging by means of abdominal CT revealed a tumor 11 × 10？cm in size on the inferior side of the liver, which displaced the right kidney (Figure 1). Swelling was also observed in the lymph nodes around the inferior vena cava. MRI revealed an adrenal tumor exhibiting low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging. At