PMC5287957_01
Case 1. (A) MRI showing enhanced lesions in the right pedicle and facet of L3 and the right ilium. (B) Hematoxylin and eosin-stained histological sections from the biopsy specimen confirmed extraadrenal pheochromocytoma. (C) The location of 2-step surgery. In the first operation, paraganglioma in L3 was resected and reconstructed with a screw and rod system; 6 months later, osteoplasty procedure by cement was done in the right posterior ilium.
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F1
Two extraadrenal pheochromocytomas were found, with no recurrence of the primary tumor (Fig. 1A). Pathological examination was positive for chromogranin A, synaptophysin and P53, occasionally positive for S-100, but negative for melan-A and calretinin, which confirmed the diagnosis of pheochromocytoma (Fig. 1B). The patient instead gave permission for percutaneous osteoplasty by polymethylmethacrylate to be performed under local anesthesia (Fig. 1C).
PMC5287957_02
Case 2. (A) Computed tomography showing the lesion in the sacrum. (B) 99mTc HYNIC TOC SPECT/CT scans showing uptake in the same area. (C) The back wall of the S1 vertebral body was deficient and the cement leaked into the canal. (D) Hematoxylin and eosin-stained histological sections from the biopsy specimen confirmed extraadrenal pheochromocytoma. (E) Decompression operation was undertaken 2 months after the sacroplasty procedure.
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F2
Computed tomography and plain radiography revealed a soft mass outside the sacrum, as well as a compressed dural sac, which was confirmed by bone scanning (Fig. 2A and B). Cement augmentation was performed to destroy the functional tumor with temporary embolization of the internal iliac artery under local anesthesia (Fig. 2C). Pathological examination confirmed the diagnosis of pheochromocytoma (Fig. 2D). Six months later, surgical decompression was performed to improve the impairment caused by the cement (Fig. 2E), with intraoperative blood loss of 400 mL.