Pheochromocytoma and gastrointestinal stromal tumors in patients with neurofibromatosis type i

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Myrella Vlenterie - , Radboud University Nijmegen (Author)
  • Uta Flucke - , Radboud University Nijmegen (Author)
  • Lorenz C. Hofbauer - , Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden (Author)
  • Henri J.L.M. Timmers - , Radboud University Nijmegen (Author)
  • Joerg Gastmeier - , University Hospital Carl Gustav Carus Dresden (Author)
  • Daniela E. Aust - , Institute of Pathology, University Hospital Carl Gustav Carus Dresden (Author)
  • Winette T.A. Van Der Graaf - , Radboud University Nijmegen (Author)
  • Pieter Wesseling - , Radboud University Nijmegen (Author)
  • Graeme Eisenhofer - , Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus Dresden (Author)
  • Jacques W.M. Lenders - , Radboud University Nijmegen, University Hospital Carl Gustav Carus Dresden, Department of Internal Medicine 3 (Author)

Abstract

Background: Neurofibromatosis I may rarely predispose to pheochromocytoma and gastrointestinal stromal tumors. Methods: A 59-year-old woman with neurofibromatosis I presented with pheochromocytoma of the left adrenal gland. During surgery, 3 gastrointestinal stromal tumors adjacent to the stomach and small intestine were removed. Despite appropriate thrombosis prophylaxis, the patient died of a pulmonary embolus 2 days postoperatively. The second patient, a 55-year-old man with neurofibromatosis I and bilateral pheochromocytomas, had several small gastrointestinal stromal tumors adjacent to the jejunum during surgery. A review of the literature was conducted to identify patients with neurofibromatosis I with concurrence of pheochromocytoma and gastrointestinal stromal tumors and to define the specific clinical features of these patients. Results: In addition to our 2 patients, 12 other cases of neurofibromatosis I with concomitant occurrence of pheochromocytomas and gastrointestinal stromal tumors have been reported. Pheochromocytomas had adrenal locations in all patients. Two of the 14 patients had a mixed pheochromocytoma/ganglioneuroma. In 4 of the 14 patients, gastrointestinal stromal tumors were located along the stomach. The gastrointestinal stromal tumors in our 2 patients showed no somatic mutations in KIT and PDGFRA genes. A pulmonary embolism was diagnosed in 4 patients. Conclusions: The simultaneous occurrence of pheochromocytoma and gastrointestinal stromal tumor should be considered in all patients with neurofibromatosis I presenting with an abdominal mass with symptoms suggestive of pheochromocytoma. Therefore, a pheochromocytoma should be excluded before a patient with neurofibromatosis I undergoes surgery for a gastrointestinal stromal tumor because an undiagnosed pheochromocytoma carries a high risk of life-threatening cardiovascular complications during surgery. Finally, this combination may be associated with an increased risk for thromboembolic events, but more studies are necessary to confirm this.

Details

Original languageEnglish
Pages (from-to)174-180
Number of pages7
JournalAmerican Journal of Medicine
Volume126
Issue number2
Publication statusPublished - Feb 2013
Peer-reviewedYes

External IDs

PubMed 23331445
ORCID /0000-0002-8691-8423/work/164617561

Keywords

ASJC Scopus subject areas