XXXX : a clinicopathologic study of four cases.

@entity1 @entity101 @entity1911 @entity5 @entity10163 @entity2922 @entity10 @entity774
This study presents the clinicopathologic findings in four new cases of @entity774 . The @entity1 presented with episodic @entity101 frequently associated with palpitations, @entity10 , and diaphoresis. All four had elevated urinary @entity2922 levels during attacks, and were thought clinically to have a @entity1911 . In each case laparotomy revealed a diffusely enlarged @entity10163 without a discrete @entity5 . Histologic examination of the adrenals demonstrated a diffuse and nodular expansion of the medulla confirmed by morphometric study. Of the four @entity1 , three underwent unilateral and one bilateral adrenalectomy. Two @entity1 who underwent unilateral adrenalectomy have been free of symptoms for three years. Thus, it would appear that @entity774 may occur unilaterally or asynchronously in the two glands. The bilaterally adrenalectomized @entity1 has had persistent attacks, suggesting that the stimulus to @entity774 may possible affect other chromaffin tissues. On the basis of our cases and a review of the literature, we propose the following criteria for the diagnosis of @entity774 : a clinical history of episodic attacks suggesting @entity1911 (generally with associated increased urinary @entity2922 levels), an @entity10163 showing diffuse expansion of the medulla into the alae or tail of the gland with or without nodule formation, a medulla composed of enlarged cells with or without pleomorphism, and, most important, an increased medulla/cortex ratio, together with an increased calculated medullary weight as determined by morphometric analysis.
