 Good morning faculty members and my dear colleagues. My name is Dr. Redhipuri. I'm second year ideology resident from Maharshi Mahakandeshwari University, Mulana, Ambala. Today's my topic is rare case report on malignant pheochromocytoma introduction. Pheochromocytomas are the rare endocrine tumors of the dinner gland that usually secrete scatocular mines. These scatocular mines secreting tumors are termed as 10% tumor in which 10% are malignant, 10% are bilateral, 10% are pediatric, 10% are familial and 10% are extradrenal. The prevalence of pheochromocytoma in patient with hypertension is 0.1 to 0.6%. 90% of the patient presenting with the combination of headache, palpitations and sweating. Malignant pheochromocytoma usually have a poor prognosis. However, accurate diagnosis and proper surgical resection might yield good clinical outcome. Now we'll discuss the case report. A 21-year-old female came to the OPTI with the chief components of vomiting, abdominal pain, difficulty in breathing with episodic headache and hypertension. Here are the blood reports. On ultrasound, there is well-defined heterogeneously hypercoic mass lesion, measuring this is seen in the relation to the right lobe of liver and upper colon of right kidney and seen anterior to the IBC with few cystic areas within it. This is the lesion. On CT, there is small well-defined oval-shaped soft tissue lesion is seen in the retroparitonium in right retroglobal or paracavel region at level of upper pool of right kidney closely abutting the lateral rim of right redness gland, showing evident enhancement on the arterial phase with washout on delayed phase with few hyperdense areas within it. No internal lesion or fat is seen. Few small hyperenhancing lesions are seen in both lobes of liver, likely vets. On CT findings. CT findings, there are few small hyperenhancing lesions are seen in bilateral lobes of liver on arterial phase but not on venous or delayed phase. The patient underwent biochemical testing. The VML levels are 38.8. Normal range is less than 8 and these are quite high. Discussion. Malignant and metastatic pheochromosatoma is a rare neuro underground tumor. These are chromathrin tumors that are rising in the adrenal medulla. Usually these are unilaterally 90% of the cases and bilateral in case of familial pheochromosatoma syndromes. Treatment is mainly surgical dissection. Chemotherapy has been used with cyclophosphate, benkystine and d-carbazine and these usually having poor prognosis. Conclusion. The case of the patient illustrated that the pheochromosatoma should be followed indefinitely as metastasis may appear at any age and may present by different aggressiveness potentials. Surgical excision is the treatment of choice for primary malignant pheochromosatoma, intensive medical blockade followed by aggressiveness, task disciplinary, surgical approach are recommended for these tumors. Long term follow-up with yearly urinary catacolysm is necessary to rule out metastasis reaccurrences or metacronous disease. Here are the references. Thank you so much.