{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:19:10Z","timestamp":1789445950199,"version":"build-2803163510"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Pheochromocytomas are rare catecholamine-secreting tumors with a high potential for recurrence post-surgery, necessitating prolonged follow-up. This case highlights the diagnostic and therapeutic challenges in managing recurrent pheochromocytoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>A 25-year-old female, with a history of left pheochromocytoma treated with adrenalectomy a decade earlier, presented with a right adrenal mass. Despite controlled hypertension, elevated urine metanephrines suggested recurrence. Imaging showed a right adrenal mass and suspicious left paraaortic lymph nodes, confirming the diagnosis of recurrent malignant pheochromocytoma in the left adrenal bed and right adrenal gland, with metastasis to the paraaortic lymph nodes. The patient underwent right adrenalectomy coupled with cytoreductive surgery (CRS) in the form of excision of left-sided adrenal bed recurrence and left paraaortic lymph node dissection, intraoperative radiation therapy (IORT), and hyperthermic intraperitoneal chemotherapy (HIPEC). On follow-up six years later, the patient remains free from recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>This case illustrates the importance of continued surveillance in pheochromocytoma patients, even those with a low-risk profile. The recurrence in this case, despite a smaller initial tumor size and no genetic predispositions, underscores the unpredictable nature of pheochromocytomas. The successful management with CRS, IORT, and HIPEC emphasizes the need for a personalized and multifaceted treatment approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pheochromocytoma patients, including those initially considered low risk, require long-term monitoring due to the risk of recurrence. The utilization of CRS, IORT, and HIPEC in this case was pivotal in managing the recurrent and metastatic malignant disease effectively, demonstrating the significance of a comprehensive, multidisciplinary treatment strategy in such complex cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.109504","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T06:41:32Z","timestamp":1710139292000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Treatment of recurrent malignant pheochromocytoma with a novel approach: A case report and review of literature"],"prefix":"10.1097","volume":"117","author":[{"given":"Marwan","family":"Alaswad","sequence":"first","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belal Nedal","family":"Sabbah","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Umair","family":"Aleem","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania","family":"Naguib","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, College of Medicine, Princess NouNrah Bint Abdul Rahman University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman Z.","family":"Azzam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek M.","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-46-20260423","first-page":"195","article-title":"Pheochromocytoma","volume":"6","author":"Bravo,","year":"1997","journal-title":"Curr. Ther. Endocrinol. Metab."},{"issue":"3","key":"R2-46-20260423","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1677\/erc.1.00829","article-title":"Malignant pheochromocytoma: current status and initiatives for future progress","volume":"11","author":"Eisenhofer,","year":"2004","journal-title":"Endocr. Relat. Cancer"},{"issue":"20","key":"R3-46-20260423","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1016\/j.jacc.2016.03.543","article-title":"Pheochromocytoma is characterized by catecholamine-mediated myocarditis, focal and diffuse myocardial fibrosis, and myocardial dysfunction","volume":"67","author":"Ferreira,","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"issue":"12","key":"R4-46-20260423","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/S0025-6196(25)18873-3","article-title":"Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979","volume":"58","author":"Beard,","year":"1983","journal-title":"Mayo Clin. Proc."},{"issue":"1","key":"R5-46-20260423","doi-asserted-by":"crossref","first-page":"32","DOI":"10.21037\/gs.2019.10.20","article-title":"Surgical approach to patients with pheochromocytoma","volume":"9","author":"Patel,","year":"2020","journal-title":"Gland Surg."},{"issue":"12","key":"R6-46-20260423","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.3390\/cancers14122942","article-title":"Postoperative recurrences in patients operated for Pheochromocytomas and Paragangliomas: new data supporting lifelong surveillance","volume":"14","author":"Parisien-La Salle,","year":"2022","journal-title":"Cancers"},{"issue":"5","key":"R7-46-20260423","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi,","year":"2023","journal-title":"Int. J. Surg. Lond. Engl."},{"issue":"5","key":"R8-46-20260423","article-title":"Recurrence of Pheochromocytoma with metastases after resection of primary tumor","volume":"12","author":"Venugopal,","year":"2020","journal-title":"Cureus"},{"issue":"6","key":"R10-46-20260423","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.surg.2014.08.044","article-title":"Predictors of recurrence in pheochromocytoma","volume":"156","author":"Press,","year":"2014","journal-title":"Surgery"},{"issue":"5","key":"R11-46-20260423","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0033","article-title":"European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma","volume":"174","author":"Plouin,","year":"2016","journal-title":"Eur. J. Endocrinol."},{"issue":"5","key":"R12-46-20260423","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1080\/02656736.2017.1301576","article-title":"Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the Peritoneal Surface Oncology Group International (PSOGI)","volume":"33","author":"Go\u00e9r\u00e9,","year":"2017","journal-title":"Int. J. Hyperth. Off. J. Eur. Soc. Hyperthermic Oncol. North Am Hyperth. Group."},{"key":"R13-46-20260423","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jss.2018.06.012","article-title":"A phase II trial of Cytoreduction and hyperthermic intraperitoneal chemotherapy for recurrent adrenocortical carcinoma","volume":"232","author":"Hughes,","year":"2018","journal-title":"J. Surg. Res."},{"issue":"5","key":"R14-46-20260423","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1080\/02656736.2017.1301576","article-title":"Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the Peritoneal Surface Oncology Group International (PSOGI)","volume":"33","author":"Go\u00e9r\u00e9,","year":"2017","journal-title":"Int. J. Hyperth. Off. J. Eur. Soc. Hyperthermic Oncol. North Am. Hyperth. Group"},{"key":"R15-46-20260423","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s12957-015-0703-6","article-title":"Cytoreduction and HIPEC in the treatment of \u201cunconventional\u201d secondary peritoneal carcinomatosis","volume":"13","author":"Cardi,","year":"2015","journal-title":"World J. Surg. Oncol."},{"issue":"Suppl. 1","key":"R16-46-20260423","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s13193-022-01593-9","article-title":"Selection factors for treatment and stratification of rare abdominal or pelvic tumors with peritoneal metastases","volume":"14","author":"Sugarbaker,","year":"2023","journal-title":"Indian J. Surg. Oncol."},{"issue":"33","key":"R17-46-20260423","first-page":"19","article-title":"Combined Intraoperative Radiotherapy (IORT) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cytoreduction Surgery (CRS) as a Novel Approach in the Management of Resectable Pancreatic Cancer","volume":"1","author":"Azzam,","year":"2020","journal-title":"Gulf J. Oncolog."},{"issue":"3","key":"R18-46-20260423","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s00066-012-0282-1","article-title":"Intraoperative radiotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Five consecutive case reports of locally advanced rectal cancer with synchronous peritoneal carcinomatosis","volume":"189","author":"Klaver,","year":"2013","journal-title":"Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al."}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261224002852?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261224002852?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1016\/j.ijscr.2024.109504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T21:03:12Z","timestamp":1776978192000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1016\/j.ijscr.2024.109504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":17,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2024.109504","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2024,4]]},"assertion":[{"value":"2024-01-22","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}