ORIGINAL RESEARCH

Veterinary Surgery
13:1Y5-200. 1YY4

Surgical Treatment of Pheochromocytoma: Technique,

Complications, and Results in Six Dogs
STEPHEN D. GILSON. D V M , STEPHEN J. WITHROW. D V M , and E. CHRISTOPHER O R T O N . D V M . r’tm

Six dogs were diagnosed with pheochromocytoma and staged according to the World Health
Organization’s system for tumor classification. Two dogs had benign tumors ( T I , NO. MO) and
lour dogs had malignant tumors (T2. NO. M I o r T3. NO, MO). All dogs had adrenalectomy, two
dogs had concurrent nephrectoniy. and three dogs had concurrent resection of a tumor thrombus
from the vena cava. Anesthetic complications occurred in five dogs, including wide variations
in heart rate (four dogs), blood pressure (five dogs). and cardiac arrythmias (one dog). One dog
died 12 hours after surgery from partial dehiscence of the suture line and hemorrhage from the
vena cava, and one dog died 6 days after surgery during general anesthesia for treatment of
laryngeal paralysis. Four dogs survived from 3 to 23 months (median. 15 months). One dog
remained hypertensive after surgery. Benign and malignant pheochromocytonias seem to be
amenable to surgical resection.
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UIDELINES for appropriate therapy and

G prognosis are poorly defined because pheo-
chromocytoma occurs infrequently in dogs.’-4 In
previous reports, surgical resection of benign pheo-
chromocytomas has resulted in survival times
of more than 2 There are no reports, to
our knowledge, describing treatment of malignant
pheochromocytoma.
The purpose of this report is to describe the sur-
gical management of pheochromocytoma in six
dogs, with specific attention to surgical treatment,
perioperative complications, and results.
MATERIALS AND METHODS
Case Select ion
Medical records were reviewed for dogs diagnosed with
pheochromocytoma at the Colorado State University
Vcterinary Teaching Hospital. Fort Collins, CO, between
January 1980 and March 1989. Six dogs treated with sur-
gical resection o f t h c tumor were sclccled for further eval-
uation. Animal patient signalment. tumor stage according
to the World Health Organization’s classification of tu-
mors,‘ animal patient management (preoperative. ancs-
thetic, surgical, and postoperative). survival time. and
cause of death were recorded.
ilnestlicsiu
Before surgery all dogs were evaluated by a minimum
of physical examination, complete blood cell count, serum
chemistry panel, and urinalysis. Based on this information
each dog was assigned a physical status grade using the
veterinary modification of the American Society of Anes-
thesiologists Patient Classification,’ and an anesthetic
protocol was determined. Intravenous ( I V ) fluids were
administered to all dogs during surgery. Ventilation was

From the Comparative Oncology Unit and Department of Clinical Sciences. College o f Veterinary Medicine and Biomedical
Sciences, Colorado State University. Fort Collins, CO.
Supported in part by Public Health Service grant 2PO ICA29582 awarded by the National Cancer Institutc. Departnient of Human
Health Services. Bethesda. MD.
Address reprint requests to Stephen D. Gilson, DVM, Sonora Veterinary Surgery and Oncology. PO Box 12933. Scottsdale. A Z
85267.
OCopyright I994 by The American College of Veterinary Surgeons
0161-3499/94/2303-0007$3.00/0
195
196 PHEOCHROMOCYTOMA IN DOGS

maintained when necessary by a pressure-cycle ventilator. vasion or metastasis as criteria for

The electrocardiogram, systemic blood pressure, rectal
temperature, packed cell volume, total protein, pulse and
respiratory rates, and quality were monitored throughout
anesthesia.
Surgical Technique
All surgical procedures were performed via ventral
midline laparotomy. Adrenalectomy, nephrectomy, or
both were performed as previously described*.9to extirpate
all evident tumor tissue. Adjacent muscles and soft tissues
were resected as needed to ensure complete tumor re-
moval. Intracaval thrombi were removed by first isolating
the affected segment of vena cava with Rumel tourniquets
to control bleeding and prevent tumor emboli. If the tu-
mor thrombus extended cranial to the diaphragm, a cau-
dal median sternotomy was performed to access the tho-
racic vena cava. After occlusion of blood flow, the portion
of vena cava wall where the tumor thrombus invaded was
quickly excised. The thrombus was removed by exerting
traction at the tumor base with one hand, while the other
hand was used to “milk” the thrombus out by extramural
manipulation. The caval lumen was lavaged and allowed
to refill with blood to prevent an air embolus. The cut
edges of the vena cava were reapposed with a Satinsky
vascular clamp and the Rumel tourniquets released. The
vena cava was sutured with 5-0 polypropylene suture in
a simple continuous pattern. Biopsy specimens were ob-
tained from lesions suspected of being metastatic tumors.
RESULTS
Patient signalment and tumor stage are presented
in Table 1. Using the presence of local tumor in-
two dogs had benign tumors and four dogs had ma-
lignant tumors. Significant clinical findings included
hypertension (dogs no. 1 and 2), ventricular pre-
mature contractions (dogs no. 1 and 6), ascites and
dyspnea (dog no. 5), and laryngeal paralysis and as-
piration pneumonia (dog no. 1). Dog no. 2 was eval-
uated for excess catecholamine production by mea-
suring urine catecholamine and vanillylmandelic
acid concentrations in a single urine sample. Con-
centrations were standardized against urine creatine
concentration and compared with a normal control
dog. The results were inconclusive (affected dog 70
pg catecholamine/L urine and 24.2 mg vanillylman-
delic acid/L urine; control dog 9 1 pg catecholamine/
L urine and 13.2 mg vanillylmandelic acid/L urine).
A provocative phentolamine test was then performed
and seemed to be diagnostic of excess catecholamine
activity (systolic blood pressure 225 mm Hg time 0,
and 168 mm Hg 2 minutes after administration of
0.5 mg phentolamine IV). This dog was treated pre-
operatively for 14 days with propranolol(O.5 mg/kg
bodyweight orally every 8 hours) to block catechol-
amine effects on the heart. Twenty-four hours before
surgery the dog was treated with phenoxybenzamine
( 5 mg orally every 12 hours); there was no improve-
ment in hypertension.
Anesthetic Management
Anesthetic techniques varied for different animal
patient classifications. The physical status rating for

Table 1. Surgical Treatment and Results in 6 Dogs With Pheochromocytoma

Hospitalization
Dog Days
No. Signalment Tumor Stage* Surgical Treatment (Days in ICU) Survival Time Cause of Death

I 9-yr-old M borzoi T1, NO, MO Adrenalectomy 12 ( 6 ) 6 days Anesthetic death during

laryngeal surgery
2 6-yr-old SF cocker TI, NO, M1 Adrenalectomy 4(3) 3 months Alive at last contact
spaniel
3 9-yr-old F Samoyed T2, NO, M I Adrenalectomy, nephrectomy 3 (2) 12 months Unknown
4 9-yr-old SF Afghan T3, NO, MO Adrenalectomy, partial resection 6 (3) 23 months Metastatic fibrosarcoma
hound of vena cava and
thrombusectomy
5 1 I-yr-old M poodle T3, NO. MO Adrenalectomy, nephrectomy, 10 (4) 18 months Alive at last contact
partial resection of vena cava
and thrombusectomy
6 9-yr-old F T3. NO. MO Adrenalectomy, partial resection 3 (0.5) 12 hours Hemorrhage from vena
of vena cava and cava
thrombusectomy

Abbreviations: M. male; F, female; and SF, spayed female.

* TNM classification, World Health Organization.
 GILSON, WITHROW, AND ORTON 197

four of six dogs was class 3 or 4 (Table 2), corre- Table 2. Circulatory Status and Supportive Therapy During
Anesthesia for 6 Dogs With Pheochromocytonia
sponding to major or extreme physiological distur-
bance. Two dogs were rated as class 1 or 2, corre- Crystalloid
sponding to none or minor systemic disturbance. Systolic Blood Fluid
Heart Rate Pressure Dose
Five of six dogs were premedicated; dogs no. 2 and Dog Physical Beats/Min m m Hg (m L/kg/
5 with atropine (0.04 mg/kg subcutaneous [SC]) and No. Status' (Mean t SD) *
(Mean SD) hr)
oxymorphone (0.1 mg/kg SC), dog no. 3 with atro-
1 4 140-220 100-I90 15
pine and acepromazine (0.1 mg/kg SC), dog no. 4 (I04 f 28) (127 t 23)
with atropine, acepromazine (0.05 mg/kg SC), and 2 3 60- 150 100-180 19
oxymorphone, and dog no. 6 with oxymorphone ( 1 1 4 t 19) (I51 k 21)
only. Anesthetic induction was by thiopental ( 10 mg/ 3 1 110-140 50- I00 15
( 1 1 9 k 9) ( 77 2 13)
kg IV to effect) (dogs no. 2 and 3 ) , by inhalation of 4 2 120-160 50- I30 21
oxygen and halothane (dogs no. I , 4, and 5), or by (141 t 1 1 ) ( 80 +- 23)
isoflurane (dog no. 6). 5 3 70- I50 60- I80 26
(119223) (105 2 26)
All of the dogs experienced some anesthetic com- 6 3 90- I70 80-240 24
plication except for dog no. 3 . Wide variations in ( 1 2 9 t 29) (120 t 34)
heart rate occurred in four of six dogs. Dog no. 2
had bigeminy and trigeminy requiring intraoperative Abbreviation: SD, standard deviation.
* Determined using veterinary modification of American Society of
treatment with lidocaine (1 mg/kg IV). Wide vari- Anesthesiologists patient classification.
ations in blood pressure occurred in five of six dogs.
Hypertension was controlled by avoiding manipu-
lation of the tumor until vascular isolation was technically impossible to remove the neoplasms en
achieved and hypotension was treated with volume bloc. In these two dogs caudal sternotomy was per-
replacement using crystalloid fluids. Three dogs re- formed to access the thoracic vena cava, and the
quired unusually high doses of crystalloid fluids to extracaval mass was removed first, then the intra-
maintain circulatory competancy (Table 2). Hypo- caval tumor thrombus was removed. Dogs no. 3 and
tension in dog no. 6 became persistant during surgery 4 had possible liver metastases, and dog no. 5 pos-
and unresponsive to IV boluses of crystalloid fluids. sible metastases to the liver and contralateral kidney.
Treatment with dobutamine (5 pg/kg/min IV con- The pheochromocytoma affecting dog no. 4 was
stant infusion) was required to maintain adequate found incidentally during laparotomy for removal
blood pressure. Dog no. 6 also received 300 mL of of a lipoma. Operative times ranged from 1.75 to
packed red blood cells IV during surgery, and 100 2.75 hours (median, 2.6 hours).
mL of fresh whole blood after surgery to raise he- After surgery, four of six dogs recovered without
matocrit and total protein concentration and help complications. Dog no. 1 had an uneventful recovery
maintain intravascular volume. Assisted ventilation from adrenalectomy, but died 6 days later during
was required in dogs no. 5 and 6 because of an open anesthesia for laryngeal surgery. Dog no. 6 remained
thoracic cavity, and in dog no. 2 because of hypo- hypotensive and anemic after surgery in spite of a
ventilation. blood transfusion and dobutamine administration.
Twelve hours after surgery the dog had a cardiac
Surgical Management arrest and could not be resucitated. Necropsy find-
ings showed that the dog had hemorrhaged from
All dogs had unilateral adrenalectomy. Two dogs partial dehiscence of the suture line in the caudal
had concurrent nephrectomy because of local tumor vena cava.
invasion (dog no. 3 also had a tumor thrombus in All surviving dogs were monitored in the intensive
the renal vein). Three dogs had concurrent resection care unit for several days. The duration of hospital-
of the caudal wall of the vena cava and removal of ization was less than a week for three dogs (Table
an intracaval tumor thrombus (Table 1). Four dogs 1). Survival times for dogs no. 2, 3 , 4, and 5 ranged
had en bloc removal of their tumors without inter- from 3 months to 23 months (median, 15 months)
ruption of tumor margins. Dogs no. 5 and 6 had with dogs 2 and 5 still alive at last owner contact.
such large tumors and intracaval thrombi that it was Dog no. 2 had persistent hypertension but was irn-
198 PHEOCHROMOCYTOMA IN DOGS
proved from preoperative values (range, systolic 147
to 160 mm Hg; diastolic 97 to 105 mm Hg). No
further diagnostic tests or treatments were per-
formed, and the dog was lost to follow-up after 3
months. Biopsy results of suspected metastatic le-
sions for dogs no. 4 and 5 were normal, and for dog
no. 3 biopsy specimens were diagnostic of metastatic
pheochromocytoma. None of the dogs in this study
could have their deaths conclusively attributed to
metastasis of their tumors.
DISCUSSION
Results of our study indicate that surgical treat-
ment of benign and malignant pheochromocytomas
can provide prolonged survival. However, careful
animal patient preparation and perioperative man-
agement are important to minimize surgical- and
anesthetic-related morbidity and mortality. The sur-
gical mortality rate in this group of dogs was 17%
(one of six dogs). In humans, recent studies report
operative mortality rates of 0%to 5%."-15 Pregnancy,
recurrent tumor, and acute pheochromocytorna
(patient with a sudden often fatally progressive hy-
pertensive crisis), are factors in humans that increase
the risk of treatment and increase mortality rates to
30% to 50%.'3.'4These conditions were not recog-
nized in dogs in this study, however, previous reports
of pheochromocytoma in dogs have described pre-
sentations of acute cardiovascular collapse similar
to acute pheochromocytoma syndrome in people,
and all cases had a fatal outcome.','
The propensity for vascular invasion and forma-
tion of an intravascular tumor thrombus is well doc-
umented in dogs.'".5 When tumor invasion is pres-
ent, special preparation and surgical management is
required, emphasizing the need for adequate tumor
staging before surgery. Tumors should be staged ac-
cording to the World Health Organization's TNM
system. Recommended diagnostic tests for staging
include a minimum of thoracic radiographs, and ab-
dominal ultrasound e~aluation.'~.'' With large or
invasive tumors, caudal vena caval angiography and
excretory urography is also performed.' If available,
computed tomography, magnetic resonance imag-
ing, and nuclear scintigraphy can be
In addition to anatomic staging of tumors, eval-
uation for physiological activity is important. An-
esthetic complications occurred in five of six dogs,
and were seemingly related to excess catecholamine
activity. Recognition and management of hyperca-
techolaminemia before surgery would likely have
mitigated some of the complications. Although dog
no. 2 was evaluated for excess catecholamine pro-
duction (urine catecholamine and vanillylmandelic
acid concentrations) and treated with alpha and beta-
adrenergic blocking agents before surgery, in com-
parison with the standards of diagnosis and treat-
ment for humans it could be argued that the methods
of catecholamine measurement and adrenergic
blockade were inadequate. In humans, measurement
of urinary catecholamines and their metabolites
from a single sample is highly inaccurate. Measure-
ment of a 24-hour urine or resting plasma samples
is preferred, and has reported sensitivity and speci-
ficity of 80% to 100%.'9-22 Appropriate methods for
use in dogs are not known, but it is likely that phys-
iological variations in catecholamine secretion in
dogs are similar to humans, and that measurement
of a 24-hour urine or resting plasma sample would
be more accurate.
Also different from the typical management of
humans, propranolol was administered to dog no. 2
for 14 days, and phenoxybenzamine for 1 day before
surgery. There was no improvement in the hyper-
tension, and this was probably because of the brief
administration time of phenoxybenzamine. Fur-
thermore. hypertension in this dog may have been
exacerbated by use of beta-adrenergic blockade
without alpha blockade. Use of these drugs in this
fashion should be avoided because unopposed beta
blockade can result in a severe pressor response. In
humans, prolonged treatment (7 to 10 days) with
alpha-adrenergic blocking agents and intravascular
volume expansion is routinely instituted before sur-
gery in an effort to control wide fluctuations of blood
pressure and heart rate during anesthe~ia.'~,'~-'~ This
therapy also decreases postoperative hypotension
resulting from marked loss of vascular tone after tu-
mor removal and an acute decrease in circulating
catecholomine levels. If tachycardia or other anyth-
mias persist after administration of alpha-adrenergic
blockers, then a beta-adrenergic blocking drug is
added.I1.?0-??Most dogs in this study had wide fluc-
tuations in heart rate and blood pressure, and re-
quired treatment with large volumes of fluid intra-
operatively. Although circulating catecholamine
concentrations or blood volumes were not measured
to prove the need for adrenergic blockade and vol-
 GILSON, WITHROW, AND ORTON
ume expansion, some dogs might have benefited
from this therapy. For future cases it is recom-
mended that serum or urine catecholimines be mea-
sured to determine if a pheochromocytoma is active,
and, if so, that appropriate adrenergic blockade and
volume expansion be instituted before surgery.
When considering resection of a pheochromocy-
toma, preoperative planning is important to mini-
mize surgery time. As noted in our study the median
surgery time was 2.6 hours, and four of six dogs had
anesthesiology physical status ratings of 3 or 4. An-
imal patient preparation should allow for a potential
thoracotomy, and anesthesia personnel should be
prepared to provide ventilatory support. The surgeon
must be knowledgable of general, oncological, and
vascular surgical techniques. We recommend a ven-
tral midline abdominal approach for removal of
pheochromocytomas because they are often large.
This approach allows for staging, and provides ex-
posure for vascular resection or nephrectomy. A lat-
eral flank approach23may be simpler and more ap-
propriate for a small, localized, and accurately staged
tumor.
After laparotom y, exploration is performed to af-
firm tumor staging. In humans, pheochromocyto-
mas occur at extra-adrenal sites in approximately
10%of patient^.".'^ Common sites include the blad-
der, the pelvic canal, and the organs of Zuckerkandl
(small masses of chromaffin tissue near the
sympathetic ganglia along the aorta, just below the
inferior mesenteric Although extra-ad-
renal pheochromocytomas are rare in animals, they
have been r e p ~ r t e d , ' . 'and
~ these similar locations
should be examined.
Surgical resection must be aggressive enough to
ensure complete tumor removal, and resection
should be en bloc whenever possible. Based on our
experience with dog no. 5 , it seems that violation of
tumor margins during resection may still result in
prolonged survival, but should only be done when
absolutely necessary. Vascular isolation is achieved
as early as possible, and tumor manipulation is min-
imized to prevent shedding of tumor emboli and
reduce the effects of iatrogenic catecholamine release.
The presence of an advanced-stage tumor is not a
contraindication to resection. Three dogs in this
study lived for 12 to 23 months after removal of
locally extensive disease (ie, T2 and T3 stages). In
humans recurrence rates after excision of advanced-
199
stage tumors are approximately 1 O%, and survival
durations greater than 5 years are frequently re-
ported. 13. f 4 20
Appropriate treatment for metastatic lesions in
dogs is unknown at present, and no conclusions can
be made from this study. Interestingly, dog no. 3
lived 12 months with multiple hepatic metastases,
and many human patients survive for years with
metastatic disease. In people, isolated metastatic tu-
mors are generally removed when noticed during
laparotom y. '3,14,20 Because no effective adjuvant
therapies are known for pheochromocytoma in an-
imals, we currently recommend that isolated, easily
resectable metastases be removed, and that extensive
metastases be managed medically for symptom
control.
The reason for persistant hypertension after sur-
gery in dog no. 2 was not determined. Approximately
20% to 25% of humans remain hypertensive after
apparently complete removal of a pheochromocy-
toma. In one study persistant hypertension was more
likely to occur if patients had sustained constant
versus paroxysmal hypertension before surgery. "
Persistant hypertension can result from an unknown
metastatic pheochromocytoma or other systemic
disease (eg, Cushing's disease, diabetes mellitus, and
cardiovascular disease).
In summary, surgical resection of benign and ma-
lignant pheochromocytomas can provide prolonged
survival even with advanced-stage tumors. Preop-
erative measurement of catecholamine concentra-
tions and blood pressure should be made, and when
necessary, treatment with alpha-adrenergic blocking
drugs and volume expansion instituted to minimize
wide fluctuations in blood pressure. Tumors should
be staged as completely as possible before surgery to
prepare, when necessary, for thoracotomy and ex-
tensive resection. Potential complications after sur-
gery include hemorrhage, hypotension, persistent
hypertension, and tumor recurrence.
REFERENCES
I . Howard EB, Nielsen SW: Pheochromocytomas associated
with hypertensive lesions in dogs. J Am Vet Med Assoc
147:145-251, 1965
2. Bouyad H, Feeney DA, Caywood DD. et al: Pheochro-
mocytoma in dogs: I3 cases ( 1980-1985). J Am Vet Med
Assoc 191:1610-1615, 1987
3. Schaer M: Pheochromocytoma in a dog: A case report.
J Am Anim Hosp Assoc 16583-587. I980
 PHEOCHROMOCYTOMA IN DOGS
4. Twedl DC. Tilley LP, Ryan WW. el al: Grand Rounds
Confcrence: Pheochromocytoma in the caninc. J Am
Anim Hosp Assoc l1:491-496. 1975
5 . Twedt DC, Wheeler SC: Pheochromocytoma in the dog.
Vet Clin North Am Small Anim Pract 14:767-782. 1984
6. Owen LN: TNM Classification of Tumors in Domestic an-
imals (ed I ) . Geneva, Switzerland. World Health Orga-
nization. 1980
7. Sawyer DC: Anesthetic considerations in surgery, in Slatter
DH (cd):Textbook of Small Animal Surgery. Philadelphia.
PA. Saunders. 1985. pp 2594-2603
8. Scavelli TD: Adrenalectomy, in Bojrab MJ (cd): Current
Techniques in Small Animal Surgery (cd 3). Philadelphia,
PA, Lea & Febigcr, 1990, pp 43 1-434
9. Roscn E: Nephrectomy. in Bojrab MJ (ed): Current Tcch-
niqucs in Small Animal Surgery (ed 3 ) . Philadelphia. PA.
Lca & Febiger, 1990, pp 367-369
10. Capen CC: Adrenal mcdulla. in Juhb KVF, Kennedy CP,
Palmcr N (eds): Pathology of Domestic Animals (ed 3 ) .
Orlando. FL, Academic, 1985, pp 392-394
I I . Capen CC: Tumors of the adrenal medulla, in Moulton J
(ed): Tumors in Domestic Animals (ed 3). Berkeley. CA.
University of California Press, 1990. pp 579-583
12. Stenstrom G, Ernest I, Tisell LE: Long-term results in 64
patients operated upon for pheochromocytoma. Acta Med
Scand 223:345-352, I988
13. Freier DT. Eckhauser FE, Harrison TS: Pheochromocytoma
a persistently problematic and still potentially lethal dis-
ease. Arch Surg I 15:388-39 I , I980
14. Harrison TS, Freier DT, Cohen EL, et al: Recurrent pheo-
chromocytoma. Arch Surg 108:450-454, 1974
15. Newell KA, Prinz RA, Pickelman J, et al: Pheochromocy-
toma multisystem crisis: A surgical emergency. Arch Surg
123:956-959, 1988
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16. Poffenbarger EM. Fccney DA, Hayden DW: Gray-scale ul-
trasonography in the diagnosis of adrenal neoplasia in
dogs: Six rases ( I98 1- 1986). J Am Vet Med Assoc 192:
228-232, 1988
17. Kantrowitz BM. Nyland TG. Feldman EC: Adrenal ultra-
sonography in the dog. Detection of tumors and hyper-
plasia in hyperadrenoorticism. Vet Radio1 27:9 1-96, 1986
18. Voorhout G: X-ray-computed tomography. nephrotomog-
raphy. and ultrasonography of the adrenal glands of
hcalthy dogs. Am J Vet Res 5 I :625-63 1. I990
19. Havlik RJ. Cahow E. Kinder BK: Advances in thediagnosis
and trcatment of pheochromocytoma. Arch Surg 123:626-
630. 1988
20. Norton JA, Doppman JL. Jcnsen RT: Cancer of the en-
docrine system. in DcVita VT. Hcllman s. Rosenberg SA
(eds): Cancer: Principles and Practice of Oncology. Phil-
adelphia. PA. Lippincolt. 1989, pp 1286-1 303
2 I . Bravo EL. Giflord RW: Pheochromocytoma: Diagnosis. lo-
calization and management. N Engl J Med 31 1:1298-
1303. 1984
22. Aron DC: Diagnosis and management of pheochromocy-
toma. Proceedings of American College of Veterinary In-
ternal Medicine. San Diego. CA 1992. pp 195-196
23. Johnson DE: Adrenalcctomy in the dog, in Bojrab MJ (ed):
Current Techniques in Small Animal Surgery (ed 2). Phil-
adelphia, PA. Lea & Febigcr. 1983. pp 386-389
24. Sutton MGSJ, Shcps SG, Lie JT: Prevalence of clinically
unsuspected pheochromocytoma. Review of a 50 ycar au-
topsy series. Mayo Clin Proc 56:354-360. 1981
25. Patnaik AK. Erlandson RA, Licberman PH. ct al: Extra-
adrenal pheochromocytoma (paraganglioma) in a cat.
J Am Vet Med Assoc 197:104-106. 1990
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