This case showed small, irregular nests of tumor cells separated by abundant sclerotic stroma. Note the degenerative atypia in some of the nuclei. The treatment of pheochromocytoma is complete resection via laparoscopic adrenalectomy. For larger or surgically difficult tumors, open approaches have been used. In the setting of familial syndromes like MEN2 and VHL where the tumors are more frequently bilateral and the risk of malignancy is low, partial cortical-sparing adrenalectomy is advocated to prevent the need for lifelong hormone replacement. Pharmacologic management of excess catecholamines during peri-operative period is an important part of management. This is to prevent dangerous elevation of blood pressure and cardiac arrhythmias that may be precipitated by catecholamine release during intraoperative manipulation of the tumor. For details of pharmacologic management, please refer to next image.