Anterior mediastinal paraganglioma: A case for preoperative embolization

Shakir, Murtaza; Blossom, G. B.; Lippert, John

doi:10.1186/1477-7819-10-134

Cited by 13 publications

(15 citation statements)

References 6 publications

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“…In functional forms, a suspect of endothoracic paraganglioma can be suggested by typical symptoms caused by secretion of catecholamines: in case of hypertension (often paroxysmal) associated to the classic triad (headaches, palpitations and sweating), the specificity is reported to be more than 90% (14). These patients should undergo biochemical tests for the determination of the serum and urine levels of fractionated metanephrines, which is reported to be the most sensitive and specific examination for the diagnosis of such tumors (14,22,23).…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary and mediastinal paragangliomas: rare endothoracic malignancies with challenging diagnosis and treatment

Palma¹,

Lorusso²,

Gennaro³

et al. 2018

J. Thorac. Dis

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Background: Pulmonary and mediastinal paragangliomas are rare tumors that may have neuroendocrine activity or be non-functional, incidental, in asymptomatic patients, or causing mass effect symptoms. Although being low-grade tumors, they can display an aggressive behaviour, developing local infiltration and distant metastases. We report our experience with three endothoracic paragangliomas and a Literature review, to point out diagnostic difficulties and problems related to surgical treatment. Methods: From 2009 to 2017, we treated 3 patients with histological diagnosis of paraganglioma: 2 pulmonary, 1 mediastinal. No one presented catecholamine-secreting syndromes; pulmonary cases were asymptomatic, while the mediastinal one had aspecific cough and dyspnea. Imaging diagnosis was based on chest computerized tomography (CT) and magnetic resonance imaging (MRI) scan. No patient had preoperative histological diagnosis. Intraoperative pathological examination was suggestive for malignancy: in pulmonary cases, wedge resection and lobectomy were performed; the middle mediastinal mass was completely removed after challenging dissection, isolation and section of numerous vascular pedicles. Results: Postoperative course was uneventful in all cases. No patient received adjuvant treatments. At a median follow-up of 47 months (range, 6-102 months), two patients are alive, without local or distant recurrence; one patient died 6 months after surgery, due to disease progression. Conclusions: Endothoracic paragangliomas, rare and often asymptomatic tumors, are of difficult diagnosis and should be considered malignant tumors, due to the potential aggressive behaviour of cases with high mitotic index and the frequent possibility of recurrence and metastases. Surgical resection is the treatment of choice and careful intraoperative manipulation is recommended, due to the high vascularity of these tumors, to prevent complications. After complete excision, long-term prognosis is generally good. However, even after surgical removal, a close, periodical and lifelong follow-up is mandatory.

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Section: Discussionmentioning

confidence: 99%

“…Paragangliomas can show a tendency to local invasion and/or develop distant metastases, with a reported incidence of malignancy between 21% and 76% (2,(9)(10)(11)18,22).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and mediastinal paragangliomas: rare endothoracic malignancies with challenging diagnosis and treatment

Palma¹,

Lorusso²,

Gennaro³

et al. 2018

J. Thorac. Dis

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“…Preoperative arterial embolization of pheochromocytomas or paragangliomas is not routinely performed because of the theoretical risk of catecholamine release in circulation resulting in hypertensive crisis. However, it can be performed under strict monitoring to reduce vascular supply in large, hypervascularized tumors, thus facilitating surgical excision [ 13 – 16 ]. However, there are no indications that this procedure significantly reduces perioperative blood loss, surgical time, or hospital stay [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Paraganglioma-Induced Cardiogenic Shock Rescued by Preoperative Arterial Embolization

Houari

Soumaya

Salhi

et al. 2018

Case Reports in Critical Care

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Background Catecholamine-induced cardiogenic shock is a rare manifestation of paragangliomas. The high mortality rate of this condition makes the immediate, multidisciplinary approach mandatory. Case Report We report a case of an 18-year-old woman with a retroperitoneal secreting paraganglioma, complicated with a cardiogenic shock and an acute adrenergic myocarditis, requiring hemodynamic support and emergency arterial embolization prior to surgical excision, with a favorable outcome. Conclusion Paraganglioma-induced myocarditis is rare but can be dramatic. Management requires appropriate and immediate hemodynamic support. Embolization may be an alternative to stabilize the patient prior to surgery.

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“…1 In pelvic or head and neck paraganglioma, preoperative tumor embolization is often used to reduce hemorrhage risk at the time of surgery. [6][7][8] Tumor embolization for cardiac paragangliomas has been suggested 9-11 but is not widely used. A multidisciplinary planning session with the cardiac surgeon, anesthesiologist, perfusionist, and perioperative nursing teams before surgery facilitates adequate preparation of resources for intraoperative management.…”

Section: How Should This Patient Be Prepared Preoperatively To Minimimentioning

confidence: 99%

“…2,3 Only a small percentage (3%) of all paragangliomas are thoracic in location, 4 and when contiguous with cardiac structures, they are referred to variably in the literature as "cardiac paraganglioma," "cardiac pheochromocytoma," "intrapericardial pheochromocytoma," or "mediastinal pheochromocytoma." 3,[5][6][7] For clarity, the term "cardiac paraganglioma" is used here.…”

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confidence: 99%