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Pheochromocytoma presenting as a giant cystic tumor of the liver.

CASE REPORT A 49-year-old woman who underwent renal transplantation 3 years before admission was found to have an asymptomatic palpable right upper quadrant abdominal mass during a routine examination. Her medical history was significant for systemic lupus erythematosus with lupus nephritis and end-stage renal disease, hypertension for 3 years (which was controlled with 2 medications), and borderline diabetes mellitus. She took cyclosporine, azathioprine, and prednisone for immunosuppression. She had no family history of hypertension or endocrine tumors. An abdominal ultrasound and computed tomography scan (Fig 1) both revealed a complex 15-cm cystic mass with septations and thick irregular walls in the right lobe of the liver, consistent with a biliary cystadenoma or biliary cystadenocarcinoma. There were no signs or symptoms to suggest a hepatic abscess. Laboratory data ruled out amoeba, and serology ruled out Echinococcus. A formal right hepatic lobectomy was performed. The 15 × 12 × 12-cm cystic mass (Fig 2) was fused to the infrahepatic inferior vena cava, necessitating removal of a small piece of the front wall of the infrahepatic inferior vena cava with the cystic tumor. The right native kidney was densely adherent to the mass. The right adrenal gland was not identified but was thought to be within the hypervascular tissue removed with the specimen. During the procedure, the patient initially became hypertensive and was treated with labetalol while the cystic mass and the right hepatic lobe were being manipulated. After ligation of the short hepatic veins, the patient became hemodynamically unstable, with episodes of Pheochromocytoma presenting as a giant cystic tumor of the liver