Bilateral composite adrenal pheochromocytoma. Report of a case.

Adrenal medulla tumors containing both a pheochromocytoma and a ganglioneuroma or ganglioneuroblastoma component were first described by Hedinger in 1911. Since then, a few cases have been reported. Both components derive from neural crest cells, as demonstrated by immunohistochemistry studies using chromogranin and S100. The case of a 43-year-old hypertensive woman who had surgery in 1995 for a tumor in the left adrenal gland is reported. Her blood pressure remained elevated after the procedure, and an MIBG scintiscan demonstrated slight hyperactivity of the right adrenal gland. Histologic studies of both operative specimens established the diagnosis of bilateral pheochromocytoma with a neuroganglia component. The clinical manifestations, pathologic features, and etiopathogenesis of these composite tumors are discussed.