Acute myocardial injury induced by pheochromocytoma: a case report

Figures

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  Fig. 1. The electrocardiograph (ECG) on first medical contact. The emergency ECG showed sinus rhythm, flat or inverted T wave in leads III and aVF, and ST segment depression in leads V2-V5 by 0.05mV

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  Fig. 2. The coronary Computed Tomography Angiography (CTA) examination. The image indicates that there is no significant calcification or stenosis in the left and right coronary, and their branches

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  Fig. 3. The rechecked electrocardiograph (ECG). The first re-examination of the ECG after admission showed sinus rhythm, flat or inverted T waves in leads II, III, and aVF, and ST-segment depression in leads V2-V5 of 0.05mV, which had no significant changes compared with before admission

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  Fig. 4. The adrenal CT imaging. The enhanced CT scan showed heterogeneous enhancement, with a small non-enhancing necrotic area in the center (CT attenuation values ranged from 30 to 60 Hounsfield units), and the rest showed moderate enhancement, suggesting the possibility of left adrenergic pheochromocytoma

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  Fig. 5. The electrocardiograph during chest tightness on September 14, 2021. The review electrocardiogram of the patient on the third day of admission showed T-wave inverted in leads II, III and aVF, as well as ST-segment depressed in leads V3-V5 by 0.1 mV

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  Fig. 6. Myocardial enzymatic changes of the patient during hospitalization

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  Fig. 7. Histopathological examination of the surgical specimen. a. The resected mass had a dark brown to gray surface and measured 6.8×5.5×3.8 cm.b. On histologic examination of the hematoxylin and eosinstained specimen (magnification, 100×), cells with small round nuclei and clear cytoplasm are observed to be arranged in a nested pattern (Zellballen structure). c. Positive immunohistochemical staining for CgA in the necrotic tissue (magnification, 200×). d. Positive immunohistochemical staining for CD56 in the necrotic tissue (magnification, 200×). e. Positive immunohistochemical staining for NSE in the tumor cells (magnification, 200×). f. Positive immunohistochemical staining for synaptophysin in clear cytoplasmic cells (magnification, 200×). g. Positive immunohistochemical staining S-100 protein for in clear cytoplasmic cells (magnification, 200×). h. Positive immunohistochemical staining for SSTR-2 in clear cytoplasmic cells (magnification, 200×). i. The positive rate of Ki-67 proliferation index was about 2% (magnification, 200×)