Pheochromocytoma (PCC) and Paraganglioma (PGL) are rare neuroendocrine neoplasms. These tumors harbour disastrous consequences during surgery due to catecholamine hypersecretion if they are undiagnosed or prepared inadequately preoperatively. A 41- year- old lady presented with mild left flank discomfort. She had experienced recurrent anxiety attacks accompanied by palpitations and headache which were managed previously as panic attacks. Radiologic investigations showed a retroperitoneal mass that located anteromedial to the left kidney, separated from the left adrenal gland and adherent to the 4th duodenal segment. During admission, her vital signs showed slight elevation of blood pressure (140\90–160\110) mmHg, thus 24-h urine metanephrine and normetanephrine were requested and the results revealed normal values. Upper gastrointestinal endoscopy failed to pass beyond the 3th duodenal segment and showed no pathologic evidence. According to her findings, a diagnosis of duodenal gastrointestinal stromal tumor (GIST) was suspected. During laparotomy, crises of hypertension and tachycardia followed by severe hypotension made the resection of the misdiagnosed mass very tricky. Immunohistochemical staining studies confirmed the diagnosis of paraganglioma. Paraganglioma is a life threatening disease and should always be considered as a differential diagnosis of asymptomatic retroperitoneal mass. The aim of our study is to present a challenging case of an undiagnosed retroperitoneal paraganglioma and to alarm our colleagues from such troubles.

中文翻译：

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罕见的腹膜后副神经节瘤严重病例被误诊为十二指肠胃肠道间质瘤：一例。

嗜铬细胞瘤（PCC）和副神经节瘤（PGL）是罕见的神经内分泌肿瘤。如果无法诊断或术前准备不足，儿茶酚胺分泌过多会导致这些肿瘤在手术过程中造成灾难性后果。一位41岁的女士出现轻度的左胁不适。她经历了反复发作的焦虑发作，并伴有心pal和头痛，这些症状先前曾作为惊恐发作得到处理。放射学检查显示腹膜后肿块位于左肾的前内侧，与左肾上腺分开并附着于十二指肠第四节段。入院期间，她的生命体征显示血压略有升高（140 \ 90–160 \ 110）mmHg，因此要求使用24小时尿中肾上腺素和去甲肾上腺素，结果显示正常值。上消化道内窥镜检查未能通过十二指肠第3段，未显示任何病理学证据。根据她的发现，怀疑诊断为十二指肠胃肠道间质瘤（GIST）。在剖腹手术中，高血压和心动过速的危机继而发生严重的低血压，使得被误诊的肿块的切除非常棘手。免疫组织化学染色研究证实了副神经节瘤的诊断。副神经节瘤是危及生命的疾病，应始终视为无症状腹膜后肿物的鉴别诊断。我们研究的目的是提出一个富有挑战性的未诊断的腹膜后神经节瘤病例，并向我们的同事发出此类麻烦的警报。怀疑诊断为十二指肠胃肠道间质瘤（GIST）。在剖腹手术中，高血压和心动过速的危机继而发生严重的低血压，使得被误诊的肿块的切除非常棘手。免疫组织化学染色研究证实了副神经节瘤的诊断。副神经节瘤是危及生命的疾病，应始终视为无症状腹膜后肿物的鉴别诊断。我们研究的目的是提出一个富有挑战性的未诊断的腹膜后神经节瘤病例，并向我们的同事发出此类麻烦的警报。怀疑诊断为十二指肠胃肠道间质瘤（GIST）。在剖腹手术中，高血压和心动过速的危机继而发生严重的低血压，使得被误诊的肿块的切除非常棘手。免疫组织化学染色研究证实了副神经节瘤的诊断。副神经节瘤是危及生命的疾病，应始终视为无症状腹膜后肿物的鉴别诊断。我们研究的目的是提出一个富有挑战性的未诊断的腹膜后神经节瘤病例，并向我们的同事发出此类麻烦的警报。免疫组织化学染色研究证实了副神经节瘤的诊断。副神经节瘤是危及生命的疾病，应始终视为无症状腹膜后肿物的鉴别诊断。我们研究的目的是提出一个富有挑战性的未诊断的腹膜后神经节瘤病例，并向我们的同事发出此类麻烦的警报。免疫组织化学染色研究证实了副神经节瘤的诊断。副神经节瘤是危及生命的疾病，应始终视为无症状腹膜后肿物的鉴别诊断。我们研究的目的是提出一个富有挑战性的未诊断的腹膜后神经节瘤病例，并向我们的同事发出此类麻烦的警报。