Retroperitoneal Pheochromocytoma Presenting with Atypical Chest Pain and Labile Hypertension: A Case Report

Retroperitoneal pheochromocytoma typically presents with sustained or paroxysmal hypertension, often accompanied by the classic triad of headache, palpitations, and diaphoresis. A case of retroperitoneal pheochromocytoma presenting with atypical chest pain and labile hypertension is reported, alongside a description of the diagnostic and treatment strategies. A 74-year-old man presented with chest pain and labile hypertension, initially suggestive of acute coronary syndrome. Laboratory findings revealed a significant elevation in high-sensitivity cardiac troponin T, with no significant coronary stenosis on imaging. Contrast-enhanced computed tomography identified a heterogeneous retroperitoneal mass measuring 7.8 cm × 7.5 cm × 6.6 cm near the right kidney, raising suspicion of a neurogenic tumor. Surgical resection of the mass was performed. Postoperative histopathological examination showed tumor cells arranged in clusters and nests, while immunohistochemical staining was positive for synaptophysin, chromogranin A, S-100 protein, and CD56, supporting the diagnosis of pheochromocytoma. Following surgery, catecholamine levels normalized and blood pressure stabilized. This case highlights the diagnostic challenges of pheochromocytoma presenting with cardiovascular symptoms and suggests that pheochromocytoma may be considered in the differential diagnosis of patients with atypical chest pain and labile hypertension, particularly when cardiac symptoms are accompanied by elevated troponin levels, but no significant coronary stenosis is identified.