Clinically Silent Behavior in a Giant Pheochromocytoma with Malignant Potential: A Case Report

Aim: This case report aims to highlight the behavior of pheochromocytoma (PCC) based on its size and its malignant potential.Background: Pheochromocytomas (PCCs) are rare catecholamine-secreting tumors of the chromaffin cells of the adrenal medulla or paraganglia at other places.They usually present with a symptom triad of headache, palpitations and sweating with paroxysmal hypertension.There are also those which are asymptomatic, termed as silent/nonsecretory/nonfunctional/unsuspected.Roughly 10% are malignant in nature.Case description: We report the case of a 33-year-old male who presented with complaints of mass over the left side of the abdomen for 2 weeks which was not noticed before and is nonprogressive.Abdominal examination revealed a large retroperitoneal lump measuring 10 × 10 cm in the left hypochondrium.Contrast computerized tomography (CT) abdomen revealed a suprarenal heterogeneous mass likely arising from the adrenal glands with normal biochemical workup.He was operated on, and the mass was removed with the postoperative report suggestive of PCC with malignant potential with a PCC of the Adrenal gland Scaled Score (PASS) score of 8/10.Conclusion: This was a case of a large PCC that was nonsecretory, and usually, PCC secretory behavior correlates well with size. 2 Clinical significance: Our case highlights one of the rarer cases of a borderline PCC which was nonsecretory despite its large size.