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Summary  A 21-year-old woman was referred to our hospital to treat bilateral pheochromocytomas (PCCs) after a diagnosis of multiple endocrine neoplasia type 2A (MEN2A). We performed bilateral laparoscopic adrenalectomy. One year after the operation, urinary fractionated metanephrines in 24-h urine increased. MRI showed a 30 mm tumor on the interaortocaval region and  123 I-MIBG concentrated in this area. We excised the tumor and performed para-aortic lymphadenectomy. Histopathologic examination confirmed a PCC arising from ectopic adrenal tissue. Urinary fractionated metanephrines in 24-h urine declined to basal levels immediately after the operation. We detected no recurrence of paraganglioma or PCC for 5 years after the treatment.    Learning points:    Most ectopic adrenal tissue is associated with no symptoms and contains only the adrenal cortex.    Adrenocortical tumors sometimes arise from ectopic adrenal tissues similarly to in the normal adrenal gland.    PCC arising from ectopic adrenal tissue occurs infrequently.    MEN2-related PCC is accompanied by adrenal medullary hyperplasia, which might be part of tumorigenesis.

Pheochromocytoma arising from an ectopic adrenal tissue in multiple endocrine neoplasia type 2A