This report describes a rare adult case of composite pheochromocytoma (PCC) containing a ganglioneuroblastoma (GNB) component. The patient was a 48-year-old man who presented to the Department of Endocrinology, First Medical Center of Chinese PLA General Hospital on March 25, 2025, with a 3-month history of hypertension and a left adrenal mass discovered 12 days earlier.
Clinical presentation prompted further evaluation including biochemical testing, imaging, and surgical management. The authors performed a retrospective analysis of the patient’s diagnostic and treatment course and conducted a systematic literature search (PubMed, Embase, CNKI, Wanfang) up to October 1, 2025 to identify comparable adult cases for pooled clinicopathological analysis.
Preoperative biochemical testing showed markedly elevated normetanephrine (NMN). Imaging included magnetic resonance imaging (MRI) and 18F-NOTATATE somatostatin receptor PET-CT (18F-NOTATATE-PET-CT). Both modalities identified a cystic-solid mass in the left adrenal gland. The solid component showed increased radiotracer uptake on PET-CT with a reported maximum standardized uptake value (SUVmax) of 9.4.
These biochemical and imaging findings were consistent with a functional adrenal medullary tumor, but the authors emphasize that clinical, biochemical, and imaging features of composite PCC with GNB frequently overlap with conventional PCC and are not definitive for diagnosis without histopathology.
The patient underwent robot-assisted laparoscopic tumor resection. Postoperative histopathological examination confirmed a composite PCC, composed of a conventional pheochromocytoma component together with a ganglioneuroblastoma component. The report indicates that definitive diagnosis relied on careful pathological assessment to identify the distinct tumor elements.
The article does not report specific intraoperative hemodynamic details, perioperative complications, or the exact size of the lesion in this case beyond the imaging description; those details were not provided in the source abstract.
Germline whole-exome sequencing was performed and did not detect any clearly pathogenic variants. Following surgery the patient’s blood pressure normalized, allowing cessation of antihypertensive medication. At 6 months after resection there was no evidence of recurrence or metastasis on follow-up assessment.
The authors highlight the role of germline genetic testing in composite PCC cases because a subset of reported adult patients have been associated with hereditary syndromes; in this report no germline pathogenic variant was identified.
The authors conducted a systematic literature search across multiple databases through October 1, 2025 and identified 14 previously reported adult cases of PCC with GNB. Including the present patient, 15 adult cases were analyzed. Key aggregated findings from these cases included:
The review underscores that composite PCC with GNB in adults is exceedingly rare and that clinicopathological features overlap with conventional PCC, necessitating histopathological confirmation.
From the single-case analysis and pooled literature, the authors conclude that prognosis likely correlates with tumor composition (relative presence of pheochromocytoma vs ganglioneuroblastoma elements), tumor size, and the presence of hereditary genetic syndromes. Because clinical, biochemical, and imaging features do not reliably distinguish composite PCC with GNB from typical PCC, the following actions are recommended based on the report:
These recommendations are drawn from the authors’ analysis and pooled case data; the source abstract does not provide detailed surveillance intervals or specific genetic panels used.
All authors declared no conflicts of interest.
Note: This summary and the recommendations are restricted to the data and statements reported in the source abstract and accompanying information. The source did not report certain granular details such as exact tumor dimensions for the index case beyond imaging description, intraoperative hemodynamics, specific histologic grading metrics, or the precise gene list used for whole-exome analysis; those details were not reported in the source.