UP-49 Adrenal pheochromocytoma: tumor histology correlates with perioperative intensive care stay
Thursday June 27, 2019 from

Jiefei Yao, Canada



University of Ottawa


Adrenal pheochromocytoma: Tumor histology correlates with perioperative intensive care stay

Jiefei Yao1, Luke Witherspoon1, Eric Belanger2, Neal E. Rowe1.

1Surgery - Urology, University of Ottawa, Ottawa, ON, Canada; 2Pathology, University of Ottawa, Ottawa, ON, Canada

Pheochromocytomas (PCC) are catecholamine secreting tumours with the majority arising from the adrenal medulla. The behavior of these tumors is a challenge to predict on the basis of tumor histology. Malignant PCC is only confirmed in the presence of metastatic disease at non-chromaffin sites. Pheochromocytoma of the Adrenal Gland Scale Score (PASS)[1] is a pathologic assessment that helps identify tumors at greater risk of metastatic spread. However, the value of PASS in assessing clinical outcomes apart from metastatic disease is unknown. In our study, we aimed to assess the relationship between PASS and clinical severity of resected adrenal PCC.  

We performed a retrospective chart review on all resected PCC in a tertiary institution from 2008-2018. Pathology slides were reviewed and all specimens were assigned a PASS. Demographic information and clinical outcomes were collected for all PCC during the study period. Spearman correlation coefficients were used for comparison of continuous variables.

63 tumors were identified. Two cases were deemed to be malignant pheochromocytoma. There was no clear relationship between PASS and patient age, hypertension, cardiac presentation, metanephrine level, peak intraop blood pressure, or length of stay. Symptomatic presentations trended toward higher pass but did not reach statistical significance (6 vs 4, p=0.47). Median PASS was higher in females than males (6 vs 2, p=0.017). Patients requiring perioperative ICU admission had higher PASS than patients who did not (8 vs 5, p=0.04).

This is the first study to use PASS to assess patient outcomes beyond metastatic disease. While metastatic disease is devastating, the more common danger is related to the sequelae of catecholamine excess. We report a novel application of the PASS to confirm a relationship between tumor histology and perioperative outcome in PCC patients While this preliminary work is hypothesis generating, further studies with larger sample sizes are needed.


[1] Thompson, L. “Pheochromocytoma of the Adrenal gland Scaled Score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases.” Am J Surg Pathol 2002; 26 5:551-66 .

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