Case report of trans-renal ablation procedures for a recurrent pheochromocytoma in von Hippel-Lindau disease

Pheochromocytoma is one of recurrent tumors in patients with von Hippel-Lindau (VHL) disease. For patients with bilateral adrenal glands, unilateral adrenalectomy is the treatment of choice; however, for patients with a single adrenal gland, hemiadrenalectomy or tumorectomy can be performed instead of adrenalectomy to preserve adrenal function. Currently, adrenalectomy is recommended even if recurrent pheochromocytomas occur in the residual adrenal tissue. Consequently, adrenal insufficiency cannot be avoided in these patients. Percutaneous radiofrequency ablation (RFA) is used as an alternative treatment for preserving adrenal function; however, RFA is difficult to perform when major organs are present in the approaching pathway. The trans-hepatic approach is the only reported safe route to approach a right adrenal tumor to avoid pneumothorax. In this case report, we performed percutaneous RFA and hydrodissection through the left renal parenchyma to treat a recurrent pheochromocytoma in the small residual left adrenal tissue, which is surrounded by several critical organs. Our goal was to show our experience of image-guided trans-renal RFA and hydrodissection in a patient with VHL disease.