Figure 2

Abdominal computed tomography, ¹²³ I-MIBG scintigraphy, pathology and preperitoneal endoscopic resection of the pheochromocytoma. Axial (A) and coronal view (B) on abdominal computed tomography with intravenous and rectal contrast shows a round-shaped, sharply demarcated tumour of 1.7 by 2.5 cm possibly attached to the bladder wall just lateral to the prostate. No local (or distant) lymphadenopathy was observed. Arrowheads in red indicate the tumour. The iodine-123-metaiodobenzylguanidine (¹²³I-MIBG) SPECT-scan shows high uptake of ¹²³I in the periprostatic tumour without suspicion of catecholamine-producing tumours located elsewhere in the body (C). Furthermore, aspecific uptake can be observed in the liver and also the bladder through renal clearance of the (coupled) isotope. “R” indicates the right side of the patient and “L” indicates the liver. The red arrow indicates the tumour uptake of ¹²³I-MIBG. Hematoxylin staining of the transrectal biopsies of the tumour showed epithelial cells with dark nuclei that differed in size with local tube formation (D). In the cytoplasm of the epithelial cells, a granular pattern was observed. Immunohistochemistry of the tissue shows a positive staining for chromogranin A, CD56 and synaptofysin. Staining for PSA and PSAP, which might be indicative of prostatic tissue, were negative. The inlet illustrates the chromogranin A immunostaining on the tumour tissue. Snapshot of the camera during preperitoneal endoscopic resection of the paraganglioma shows the close proximity to the prostate (E). The peri-prostatic fat is indicated in light-blue by “PPF” and the tumour by “T”. Gross macroscopy of the 3.5 by 2.5 by 2 cm partly encapsulated tumour that was resected via preperitoneal endoscopic surgery (F).