| Objective:The clinical case data of 170 patients with postoperative pathological diagnosis of pheochromocytoma and paraganglioma(PPGL)were retrospectively analyzed to summarize the clinical treatment characteristics of PPGL,improve clinicians’ understanding of the disease,and provide a reliable reference basis for clinical treatment.Study Subjects and Methods:Clinical case data were collected from 170 patients with pheochromocytoma diagnosed through postoperative pathology.Differences in general information,preoperative examination and intraoperative blood pressure fluctuations were compared between the symptomatic and asymptomatic groups and between the small and large diameter groups.Patients’ general information,symptoms,test results,tumour size and other factors associated with intraoperative blood pressure fluctuations were analysed。Data statistics were analysed and processed using SPSS25.0 statistical software.One-sample K-S(Kolmogorov-Smirnov)was used to test the normality of the measures.Measures that conformed to a normal distribution were expressed as mean±standard deviation and assessed by independent samples t-test;for non-normally distributed measures,median and upper and lower quartile spacing were expressed as non-parametric tests for comparison between groups;statistical data were expressed as percentages.Risk factors for intraoperative blood pressure fluctuations were analysed using one-way and multi-way Logistics regression.p <0.05 was considered a statistically significant difference.Results:1.Of the 170 patients in this study,80(47.4%)were male and 90(52.6%)were female,male:female = 1:1.11.The age of onset of the disease ranged from 10 to 76 years,with a mean of 46.4±13.7 years,with the highest incidence between 41 and 60 years of age.145 of the 170 patients were first seen in urology,7 in general surgery,6in endocrinology,5 in cardiovascular medicine,2 in orthopaedics and the remaining 5in nephrology,gastroenterology and otorhinolaryngology.Endocrinology,cardiovascular medicine in 5 cases,orthopaedics in 2 cases,and nephrology,gastroenterology,otorhinolaryngology and head and neck surgery in the remaining 5case.2.98(57.6%)of the 170 patients were seen for the discovery of adrenal and other sites.62(36.5%)patients had no clinical symptoms and only 4 of the 108 patients with symptoms had the classic triad of symptoms.Other symptoms included:dizziness 52 cases,weakness 33 cases,back pain 23 cases,shortness of breath 22 cases,abdominal pain 15 cases,nausea 11 cases,frequent urination 7 cases,haematuria 5 cases,fever 3 cases,flushing,black stool and rhinorrhoea 1 case.3.The diameter of tumours in PPGL patients was between 0.2 and 21.0cm(mean value(6.79±3.08 cm),with 109 patients having a tumour diameter of less than5 cm and 61 patients having a tumour diameter of more than 5 cm.The tumour was most commonly located in the adrenal gland and extra-adrenal most commonly in the abdomen.The tumour originated in the adrenal gland in 160 cases,including 74 cases(43.5%)on the left side,81 cases(47.7%)on the right side and 5 cases(2.9%)bilaterally.The tumours originated outside the adrenal glands in 10 cases(5.9%),including 5 cases(2.9%)in the retroperitoneum,1 case(0.6%)in the bladder wall,1case(0.6%)below the left kidney,1 case(0.6%)in the para-abdominal aorta,1 case(0.6%)in the head of the pancreas and 1 case(0.6%)in the L1 cone.Of the 170 patients,57(33.5%)were hypertensive,6(3.6%)were cardio-vascular and 25(14.7%)were diabetic.4.76 of the 170 patients had 24 h urine VMA(Vanil1ylmandelic Acid,VMA),74 of which were above the upper limit of normal,a positive rate of 97.4%.147 patients had a 100% positive CT examination;1 had MRI,a positive rate of100%;31 had abdominal ultrasound,a positive rate of 65%.The postoperative pathological findings were pheochromocytoma in 170 patients,of which 11(6.5%)had exudate/necrotic blood,11(6.5%)had tumour cell anisotropy,10(5.9%)had infiltration,14(8.2%)had deep nuclear staining,10(5.9%)had necrosis and 11(6.5%)had invasion of the vasculature or intravascular thrombus.Immunohistochemistry was performed in 108 patients,of whom 99(92%)had positive expression of Syn,92(85%)of Cg A and 71(65%)of NSE.Fifty-nine cases(54.6%)expressed all three positively at the same time.Of the 102 cases describing Ki-67 positivity,94(92.2%)had ≤5% positivity and 8(7.8%)had >5% positivity,Three of these cases were PGL.5.When patients were grouped together,the symptomatic group had a younger age of onset(p<0.05),longer preoperative preparation time(p<0.05)and was more likely to have intraoperative blood pressure fluctuations and concomitant diabetes than the asymptomatic group(p<0.05).The preoperative preparation time,postoperative hospital stay,total hospital stay,operative time,total hospital cost and intraoperative bleeding were all greater in the large diameter group than in the small diameter group(P<0.05)and intraoperative blood pressure fluctuations were more likely to occur(P<0.05).The results of the univariate and multifactorial Logistics analysis showed that the presence or absence of symptoms and the size of the tumour diameter were independent risk factors for intraoperative blood pressure fluctuations.Conclusion:This study found that the highest incidence in the age group between 41 and 60 years.Urology is the most common primary department for patients with pheochromocytoma,and occupancy of the adrenal glands or other sites is the most common reason for pheochromocytoma patients to be seen.The clinical presentation of pheochromocytoma varies widely among individuals.The characteristic clinical presentation is hypertension with the classic triad of headache,palpitations and sweating,but the incidence of the classic triad is very low.Other rare clinical manifestations include nausea,dizziness,chest tightness and shortness of breath,fatigue,back pain,abdominal pain and haematuria.Therefore,patients with the above symptoms and combined with adrenal or other sites of occupancy should be alerted to the possibility of pheochromocytoma.PPGL has the highest proportion of patients with hypertension,followed by diabetes.Ultrasound,CT and MRI are commonly used for the local diagnosis of pheochromocytoma,with CT and MRI having a higher positive rate than ultrasound and being the imaging method of choice.PPGL is characterized by round or ovoid nuclei,abundant cytoplasm,obvious nucleoli,nuclear heterogeneity and deep nuclear staining,rare nuclear divisions,infiltration and invasion of a small number of tumour cells.The diagnosis of pheochromocytoma is significant when the pathological diagnosis of PPGL is positive for the expression of Syn,Cg A and NSE at the same time,Ki-67 expression is very low,typically less than 5%.The symptomatic group had a younger age of onset,longer preoperative preparation time and was more likely to have intraoperative blood pressure fluctuations and concomitant diabetes mellitus than the asymptomatic group.The postoperative length of stay,total hospital stay,operative time,total hospital cost and intraoperative bleeding were all greater in the large diameter group than in the small diameter group,and intraoperative blood pressure fluctuations were more likely to occur.The presence or absence of symptoms and the size of the tumour diameter were independent risk factors for intraoperative blood pressure fluctuations. |
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