Navigating the Diagnosis and Treatment of Extra-Adrenal Pheochromocytoma Presenting with Chronic Abdominal Pain: A Clinical Conundrum

Background: Extra-adrenal pheochromocytomas, or paragangliomas, are rare neuroendocrine tumors that present diagnostic challenges due to their nonspecific symptoms and radiologic features.Objective: To report a case of extra-adrenal pheochromocytoma presenting as chronic abdominal pain and hepatic masses, emphasizing the diagnostic and therapeutic challenges.Methods: A 36-year-old male with a history of diabetes and hypertension presented with weight loss and abdominal pain. Initial evaluation included comprehensive physical examination, laboratory tests, ultrasonography, and CT imaging of the abdomen and chest. Partial hepatectomy was performed, and the diagnosis was confirmed through histopathological and immunohistochemical analysis.Results: Imaging identified three mixed echogenic hepatic masses, with the largest measuring 5.6 x 5.4 cm. Enlarged para-aortic lymph nodes were observed, the largest being 4.0 x 3.5 cm. CT chest revealed a mass on the chest wall (7.0 x 3.0 cm) with metastatic lung nodules. Immunohistochemistry confirmed paraganglioma with positivity for chromogranin A and neuron-specific enolase.Conclusion: This case underscores the importance of considering paragangliomas in differential diagnoses of atypical abdominal masses and highlights the critical role of histopathological confirmation in guiding management.