MALIGNANT PHEOCHROMOCYTOMA ACCOMPANIED BY MICROANGIOPATHIC HEMOLYTIC-ANEMIA - A CASE-REPORT

A 63-year-old woman was in hospital for persistent backache. Four mont hs prior to admission she had been pointed out as having hypertension for the first time. On admission, she had anemia (hemoglobin 7.0 g/dl) with reticulocytosis, and a blood smear showed fragmented erythrocyte s. A bone marrow aspirate disclosed erythroid hyperplasia and invasion of cancer cells. The chest roentgenogram showed a coin-lesion of the right lung and left pleural effusion. A diagnosis of microangiopathic hemolytic anemia (MAHA) associated with carcinomatosis was made, but t he primary site of the cancer was unknown. Respiratory failure develop ed and the patient died a month later. Surprisingly, the autopsy revea led a malignant pheochromocytoma arising from the right adrenal gland with massive metastases to the lungs, liver, lymph nodes and systemic bones, and also disseminated intravascular coagulation (DIC). The DIC would probably account for the MAHA in this case. To our knowledge, th is is the first reported case of malignant pheochromocytoma accompanie d by MAHA.