Presentation
Severe low back pain radiating to the legs. Pheochromocytoma on histology following surgical intervention in the lumbar spine. Elevated serum catecholamines.
Patient Data
Large mixed solid and cystic mass sitting above the right kidney but not arising from it (displacing it posteriorly and laterally causing the upper ureter to be obstructed). The right adrenal is separate and normal (arrow). The left adrenal is also normal.
Large posteriorly centered mass infiltrating the laminae and spinous process (arrow) of L5 causing gross compression of the thecal sac and nerves roots.
Case Discussion
Pheochromocytoma is a tumor of 10% (rule of 10's) i.e. in 10% of cases malignant (as in this case), 10% extra-adrenal (as in this case) and metastasizing in 10% (as in this case).