- Case report
- Open Access
- Open Peer Review
Paraganglioma of the mediastinum: challenges in diagnosis and surgical management
© Wald et al; licensee BioMed Central Ltd. 2010
- Received: 21 November 2009
- Accepted: 31 March 2010
- Published: 31 March 2010
Mediastinal paraganglioms are rare, highly vascularized tumors arising from chromaffin tissue located in the para-aortic ganglia. Tumors tend to invade bordering structures and may also form metastasis. Up to 50% of patients are asymptomatic and diagnosis is incidental. Presenting symptoms are related to catecholamine hypersecretion or to a mass effect. Complete surgical resection remains the standard of care due to malignant potential of the tumor and poor response to chemotherapy or radiation. Strategic location of the tumor in proximity to great vessels, trachea, and recurrent laryngeal nerve poses challenge for the surgeon. We report a case of a 59-year old asymptomatic female who was incidentally diagnosed with a middle mediastinal mass on a positron-emission tomography (PET-CT) scan performed as part of breast cancer surveillance. Complete resection of the tumor was achieved using cardiopulmonary bypass. The patient recovered uneventfully and in a ten-month follow up there is no evidence of recurrence.
- Cardiopulmonary Bypass
- Standardize Uptake Value
- Typical Carcinoid Tumor
- Anterior Tracheal Wall
Ninety percent of chromaffin-cell-originating tumors are located in the adrenal gland and termed pheochromocytomas. The remaining ten percent are extra adrenal and are termed paragangliomas. Paragangliomas appear in the abdomen, pelvis, neck and mediastimun. Mediastinal paraganglioma originate from para-aortic (middle mediatsinum) and para-vertebral (posterior mediatsinum) sympathetic chain ganglia [1, 2]. Similar to pheochromocytoma, paraganglioma tumors may secrete catecholamines, however in majority of cases they are non-functional. Up to 50% of patients are asymptomatic and the diagnosis is incidental . Clinical symptoms may be related to catecholamine hypersecretion (hypertention/hyperhydrosis) or to a mass effect resulting in complains of hoarseness, dysphagia, shortness of breath and chest pain .
Upon admission, the patient denied any symptoms related neither to catecholamine hyper-secretion nor to carcinoid syndrome. Physical examination and routine laboratory results were unremarkable.
The patient has been followed-up since surgery. Currently she is asymptomatic. Both chest MRI and a whole body FDG PET-CT scan, performed 10 months postoperative, did not show evidence of recurrence.
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