Malignant paraganglioma of the posterior mediastinum a case report and review of the literature

Abstract

A case of malignant paraganglioma arising from the posterior mediastinum and presenting with a chest wall metastasis is reported with immunocytochemical and ultrastructural documentation. The pathobiologic features of this rare disease are reassessed with a review of the literature. Cytoarchitectural features do not provide reliable information regarding malignant potential. However, evidence of local invasiveness at surgical exploration and/or lack of initial surgical control are likely to be associated with synchronous or metachronous metastatic disease. Although there are clinicopathologic differences warranting distinction between benign paragangliomas arising in the anterior and posterior mediastinal compartments, there is no apparent pathobiologic difference with regard to the malignant group.

Mediastinal paragangliomas. A clinicopathologic and immunohistochemical study of 16 cases

“…A retrospective study of 16 cases of mediastinal paragangliomas was undertaken to evaluate their clinicopathologic and immunohistochemical features.…”

Magnetic resonance imaging findings of a nonfunctional mediastinal paraganglioma with an unusual presentation

“…No specific histologic feature has proven to be a reliable determinant of malignant potential in paragangliomas, and malignancy has been defined as the presence of metastases in sites where paraganglia are not normally present [1,10]. Presentation with metastatic disease, as in our case, is extremely rare, and to our knowledge, there are only a few reported cases with metastatic presentation [1].…”

“…Mediastinal paragangliomas are uncommon tumors classified as native to the anterior or posterior mediastinum because of pathobiologic differences attributed to these compartments [1,3,10]. Paragangliomas located in the posterior mediastinum arise from the region of aorticosympathetic or intravagal paraganglia, and those located in the anterior mediastinum arise either from the branchiomeric paraganglia or visceral autonomic paraganglia [1,3].…”

“…Paragangliomas located in the posterior mediastinum arise from the region of aorticosympathetic or intravagal paraganglia, and those located in the anterior mediastinum arise either from the branchiomeric paraganglia or visceral autonomic paraganglia [1,3].…”

Thoracoscopic resection of functional thoracic paraganglioma

“…1,4 Local tissue invasion, nuclear pleomorphism or mitotic activity does not necessarily imply malignancy in paraganglioma. 5 It is only by the presence of metastases, seen at the time of initial discovery or after surgical excision, that a diagnosis of malignancy can be confirmed. Laparoscopic adrenalectomy has now become the preferred approach for treating a variety of nonmalignant adrenal disorders, including pheochromocytoma.…”