Diagnostic Challenges of Abdominal Tumors Without Typical Imaging Features - From Misdiagnosis of Pancreatic Cystadenoma to Adrenal Pheochromocytoma - and the Intraoperative Response

Sep 30, 2026

Diagnostic challenges arise when abdominal tumors lack typical imaging findings, particularly in cases where asymptomatic pheochromocytoma is mistaken for other pancreatic or adrenal lesions. The report describes a 48-year-old woman with abdominal pain initially diagnosed preoperatively as pancreatic cystadenoma, followed by laparoscopic surgery. Intraoperative hemodynamic instability occurred, and histopathology confirmed adrenal pheochromocytoma. The case emphasizes limits of imaging, the need for high suspicion, and multidisciplinary optimization of preoperative laboratory evaluation to support safer intraoperative decisions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Case Report

Presentation and Preoperative Diagnosis

Intraoperative Course and Final Diagnosis

Conclusions

e-ISSN 1941-5923 © Am J Case Rep, 2025; 26: e950574 DOI: 10. 12659/AJCR.950574 Received: 2025.07.06 Accepted: 2025.10.21 Available online: 2025.11.15 Published: 2025.12.20 Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G BCDEF BCD CD AG Corresponding Author: Financial support: Conflict of interest: Diagnostic Challenges of Abdominal Tumors Without Typical Imaging Features: From Misdiagnosis of Pancreatic Cystadenoma to Adrenal Pheochromocytoma and the Intraoperative Response Haoyang Huang Dingwei Xu Zhangbin Chen Jie Huang Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China Jie Huang, e-mail: [huangjietdg@126.com](huangjietdg@126.com) This work was supported by the National Natural Science Foundation of China (Grant No. 82460518); the Kunming Medical University’s teaching research project (Grant No. 2023-JY-Y-059), and the Academic Leadership Training Program at the Second Affiliated Hospital of Kunming Medical University (Grant No. RCTDXS-202309) None declared Patient: Female, 48-year-old Final Diagnosis: Pheochromocytoma Symptoms: Abdominal pain Clinical Procedure: — Specialty: Laboratory Diagnostics • Surgery Objective: Unusual clinical course Background: Pheochromocytoma is a rare neuroendocrine tumor. Some patients are asymptomatic, and misdiagnosis is common, especially when it lacks typical imaging features. In asymptomatic patients misdiagnosed with pheochromocytoma, hemodynamic instability often occurs during surgical procedures, posing significant challenges to surgeons and anesthesiologists. This case report presents a patient who was misdiagnosed as having a pancreatic cystadenoma prior to surgery, aiming to explore the intraoperative decision-making and considerations for such cases. Case Report: A 48-year-old woman with abdominal pain was preoperatively diagnosed with pancreatic cystadenoma by imaging. Laparoscopic surgery was performed following standard procedures, including patient positioning, stomach suspension, tumor search, and tissue dissection. The surgery lasted 156 min, with minimal blood loss (50 mL). Intraoperative hemodynamic instability occurred, and the final histopathological report confirmed the tumor as a pheochromocytoma. The patient was monitored in the intensive care unit (ICU) after surgery and was discharged on the 8th postoperative day, without complications. Conclusions: Clinicians should be aware of the limitations of imaging. When dealing with abdominal tumors lacking typical features, especially those located in the adrenal gland or para-adrenal region, a high suspicion for asymptomatic pheochromocytoma is necessary. In the event of intraoperative hemodynamic instability, a high degree of suspicion for pheochromocytoma is needed. Moreover, it is crucial to strengthen multidisciplinary collaboration and emphasize the optimization of preoperative laboratory tests and examinations to compensate for the limitations of imaging studies. Surgeons need to be prepared for unexpected findings during surgery and adjust the surgical plan according to local anatomy to improve surgical safety and success rates. Keywords: Hemodynamic Monitoring • Laparoscopy • Pheochromocytoma Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/950574](https://www.amjcaserep.com/abstract/index/idArt/950574) Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Common AttributionNonCommercial-NoDeriva

FAQs

Why is preoperative misdiagnosis common in asymptomatic pheochromocytoma?

Because pheochromocytoma can be asymptomatic and may lack typical imaging features, other abdominal tumors are more likely to be suspected. When symptoms like sustained or paroxysmal hypertension are absent, the diagnosis becomes especially difficult.

What findings occurred during surgery after an initial diagnosis of pancreatic cystadenoma?

Intraoperative hemodynamic instability occurred during the laparoscopic procedure. After surgery, histopathology confirmed the tumor as adrenal pheochromocytoma.

What practical steps does the report recommend to manage such diagnostic uncertainty?

Clinicians should acknowledge imaging limitations and maintain a high suspicion for asymptomatic pheochromocytoma for adrenal or para-adrenal lesions. The report also stresses strengthening multidisciplinary collaboration and optimizing preoperative laboratory tests and examinations to compensate for imaging limitations.

Sep 30, 2026

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