{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:17:55Z","timestamp":1783448275403,"version":"3.55.0"},"reference-count":9,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare neuroendocrine tumors characterized by a universal potential for malignancy regardless of size or biochemical profile. While classic presentations involve paroxysmal hypertension, headaches, palpitations, and diaphoresis, an increasing proportion are detected incidentally through unrelated imaging. These \u2018silent tumors\u2019 often lack catecholamine-related symptoms and demonstrate absent or borderline biochemical abnormalities, signifying a substantial diagnostic challenge. Their indolent clinical profile may obscure malignant potential, leading to delayed intervention and missed opportunities for curative resection. We report a clinically and biochemically silent pheochromocytoma with regional lymph node metastasis, negative germline testing, and high-risk histopathologic features despite small tumor size and long-standing radiographic stability. This case illustrates that radiologic suspicion should prompt timely surgical management with appropriate perioperative blockade even in the absence of unequivocal biochemical confirmation. Lifelong surveillance remains essential with high-risk histology, irrespective of presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0124","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T18:20:19Z","timestamp":1774549219000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["A silent pheochromocytoma with regional metastasis and negative germline testing"],"prefix":"10.1530","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3865-8559","authenticated-orcid":true,"given":"Vasu","family":"Bansal","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallam","family":"Alrosan","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sobrina S","family":"Mohammed","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana Anan","family":"Hamdan","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shourya","family":"Tadisina","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026070713541294300_bib1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12022-022-09704-6","article-title":"Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas","volume":"33","author":"Mete","year":"2022","journal-title":"Endocr Pathol"},{"key":"2026070713541294300_bib2","doi-asserted-by":"crossref","first-page":"2804","DOI":"10.1002\/cncr.26577","article-title":"Clinical benefits of systemic chemotherapy for patients with metastatic pheochromocytomas or sympathetic extra-adrenal paragangliomas: insights from the largest single-institutional experience","volume":"118","author":"Ayala-Ramirez","year":"2012","journal-title":"Cancer"},{"key":"2026070713541294300_bib3","doi-asserted-by":"crossref","first-page":"3296","DOI":"10.1210\/jc.2017-00992","article-title":"Malignant pheochromocytoma and paraganglioma: 272 patients over 55 years","volume":"102","author":"Hamidi","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070713541294300_bib4","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3803\/EnM.2020.35.1.157","article-title":"Epidemiology and prognosis of pheochromocytoma\/paraganglioma in Korea: a nationwide study based on the national health insurance service","volume":"35","author":"Kim","year":"2020","journal-title":"Endocrinol Metab"},{"key":"2026070713541294300_bib5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1586\/eem.12.76","article-title":"Diagnosis of silent pheochromocytoma and paraganglioma","volume":"8","author":"Clifton-Bligh","year":"2013","journal-title":"Expet Rev Endocrinol Metabol"},{"key":"2026070713541294300_bib6","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2022.1021420","article-title":"Silent pheochromocytoma and paraganglioma: systematic review and proposed definitions for standardized terminology","volume":"13","author":"Constantinescu","year":"2022","journal-title":"Front Endocrinol"},{"key":"2026070713541294300_bib7","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1210\/jc.2014-1498","article-title":"Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070713541294300_bib8","doi-asserted-by":"crossref","first-page":"T123","DOI":"10.1530\/ERC-15-0261","article-title":"15 years of paraganglioma: pathology of pheochromocytoma and paraganglioma","volume":"22","author":"Tischler","year":"2015","journal-title":"Endocr Relat Cancer"},{"key":"2026070713541294300_bib9","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1210\/endrev\/bnab019","article-title":"Personalized management of pheochromocytoma and paraganglioma","volume":"43","author":"N\u00f6lting","year":"2022","journal-title":"Endocr Rev"}],"container-title":["Endocrinology, Diabetes &amp; 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