Abstract Purpose: To analyze the clinicopathological features, surgical management, and long-term prognosis of a composite pheochromocytoma (CP; pheochromocytoma combined with ganglioneuroma) arising 13 years after resection of a primary adrenal pheochromocytoma, with the aim of improving the clinical diagnosis and management of this rare neoplasm. Case presentation: A 61-year-old Han male had undergone left adrenal pheochromocytoma resection 13 years prior to the current presentation.