Severe Anemia as a Manifestation of Metastatic Jugular Paraganglioma

Abstract

\s=b\A young woman who had a right glomus jugulare paraganglioma had diffuse pulmonary metastases three years after surgical excision of the paraganglioma. Associated with these developments were profound anemia and an extraordinarily rapid ESR. These findings have been previously noted in patients with metastatic paraganglioma and have not as yet, to our knowledge, had a satisfactory explanation. Noteworthy in our patient was a diminished serum erythropoietin level, which may indicate that metastatic paragangliomas inhibit production of or interfere with maintenance of serum erythropoietin. Symptomatic palliation of the severe anemia was attained in this patient by injections of nandrolone decanoate. Follow-up examinations of patients with paragangliomas should include surveillance of the CBCs and ESR, both of which may reflect tumor activity. (Arch Otolaryngol 1983;109:269-272) We have recently treated a patient whose pulmonary disease proved to be an unusual metastasis of an uncommon tumor. The relation-

PET Scan Assessment of Chemotherapy Response in Metastatic Paraganglioma

“…12,13 The case reported illustrates the superiority of metabolic versus anatomical imaging in the assessment of response to chemotherapy in paragangliomas. Our patient derived clinical benefit from chemotherapy with resolution of her symptoms and improvement of cancerrelated anemia.…”

PET Scan Assessment of Chemotherapy Response in Metastatic Paraganglioma

“…12,13 The case reported illustrates the superiority of metabolic versus anatomical imaging in the assessment of response to chemotherapy in paragangliomas. Our patient derived clinical benefit from chemotherapy with resolution of her symptoms and improvement of cancerrelated anemia.…”

Hepatic metastatic paraganglioma 12 years after retroperitoneal paraganglioma resection: a case report

“…Paragangliomas are usually non-functioning and present as painless masses. However, severe anemia has been noted in quite a few patients with metastatic paragangliomas [17, 18]. Some researchers regard anemia to be a marker of persistent tumor activity, since hemoglobin will rise after resection of paraganglioma and fall again with the appearance of metastases [18].…”

“…Sweet et al described the anemia as hypochromic and microcytic with iron studies consistent with iron deficiency [19], but it’s still under controversy [20]. It’s postulated that paraganglioma may produce some substance that interferes with erythropoietin production, and depressed serum erythropoietin level has been demonstrated in some patients [17]. Though palliation of sever anemia was attained in patient by injection of nandrolone decanoate [17], the pathogenesis of paraganglioma associated anemia is still to be clarified.…”

“…Because of the slow growth rate of paraganglioma, even metastatic tumors are compatible with a prolonged survival [17, 19]. However, curative or palliative treatment should be considered to control symptoms, improve life quality, reduce complications and prolong survival.…”

MRI features in a malignant glomus jugulare tumour

“…Glomus jugulare tumours are usually benign lesions which grow slowly and have an insidious clinical course (Fanning et al, 1963;Rosenwasser, 1968;Medellin and Wallace, 1979;Davis et al, 1980;Schwartz and Israel, 1983). They may extend upwards into the posterior cranial fossa (CPA) or downwards through the jugular foramen to the neck.…”

PET Scan Assessment of Chemotherapy Response in Metastatic Paraganglioma

“…12,13 The case reported illustrates the superiority of metabolic versus anatomical imaging in the assessment of response to chemotherapy in paragangliomas. Our patient derived clinical benefit from chemotherapy with resolution of her symptoms and improvement of cancerrelated anemia.…”

Hepatic metastatic paraganglioma 12 years after retroperitoneal paraganglioma resection: a case report

“…Paragangliomas are usually non-functioning and present as painless masses. However, severe anemia has been noted in quite a few patients with metastatic paragangliomas [17, 18]. Some researchers regard anemia to be a marker of persistent tumor activity, since hemoglobin will rise after resection of paraganglioma and fall again with the appearance of metastases [18].…”

“…Sweet et al described the anemia as hypochromic and microcytic with iron studies consistent with iron deficiency [19], but it’s still under controversy [20]. It’s postulated that paraganglioma may produce some substance that interferes with erythropoietin production, and depressed serum erythropoietin level has been demonstrated in some patients [17]. Though palliation of sever anemia was attained in patient by injection of nandrolone decanoate [17], the pathogenesis of paraganglioma associated anemia is still to be clarified.…”

“…Because of the slow growth rate of paraganglioma, even metastatic tumors are compatible with a prolonged survival [17, 19]. However, curative or palliative treatment should be considered to control symptoms, improve life quality, reduce complications and prolong survival.…”

MRI features in a malignant glomus jugulare tumour

“…Glomus jugulare tumours are usually benign lesions which grow slowly and have an insidious clinical course (Fanning et al, 1963;Rosenwasser, 1968;Medellin and Wallace, 1979;Davis et al, 1980;Schwartz and Israel, 1983). They may extend upwards into the posterior cranial fossa (CPA) or downwards through the jugular foramen to the neck.…”

PET Scan Assessment of Chemotherapy Response in Metastatic Paraganglioma

“…12,13 The case reported illustrates the superiority of metabolic versus anatomical imaging in the assessment of response to chemotherapy in paragangliomas. Our patient derived clinical benefit from chemotherapy with resolution of her symptoms and improvement of cancerrelated anemia.…”

Hepatic metastatic paraganglioma 12 years after retroperitoneal paraganglioma resection: a case report

“…Paragangliomas are usually non-functioning and present as painless masses. However, severe anemia has been noted in quite a few patients with metastatic paragangliomas [17, 18]. Some researchers regard anemia to be a marker of persistent tumor activity, since hemoglobin will rise after resection of paraganglioma and fall again with the appearance of metastases [18].…”

“…Sweet et al described the anemia as hypochromic and microcytic with iron studies consistent with iron deficiency [19], but it’s still under controversy [20]. It’s postulated that paraganglioma may produce some substance that interferes with erythropoietin production, and depressed serum erythropoietin level has been demonstrated in some patients [17]. Though palliation of sever anemia was attained in patient by injection of nandrolone decanoate [17], the pathogenesis of paraganglioma associated anemia is still to be clarified.…”

“…Because of the slow growth rate of paraganglioma, even metastatic tumors are compatible with a prolonged survival [17, 19]. However, curative or palliative treatment should be considered to control symptoms, improve life quality, reduce complications and prolong survival.…”

MRI features in a malignant glomus jugulare tumour

“…Glomus jugulare tumours are usually benign lesions which grow slowly and have an insidious clinical course (Fanning et al, 1963;Rosenwasser, 1968;Medellin and Wallace, 1979;Davis et al, 1980;Schwartz and Israel, 1983). They may extend upwards into the posterior cranial fossa (CPA) or downwards through the jugular foramen to the neck.…”