Surgical resection of a middle mediastinal paraganglioma that caused diabetes

Abstract

Background Paragangliomas are rare neuroendocrine tumors originating from chromaffin cells of extra-adrenal origin. Ninety percent of adrenergic tumors originate in the adrenal medulla and are known as pheochromocytomas; the remaining 10% are extra-adrenal and are called paragangliomas. Mediastinum paragangliomas is rare and commonly originate from the posterior mediastinum, while those originating from the middle posterior are quite rare. Some paragangliomas secrete catecholamines, leading to symptoms such as hypertension, tachycardia, and diabetes. Case presentation A 76-year-old woman visited our hospital for the treatment and further evaluation of diabetes. Her hemoglobin A1c levels had risen to 11.0%. To investigate the cause of her diabetes, a contrast-enhanced chest computed tomography scan was performed, revealing a ring-enhancing tumor (30 × 30 mm) in the middle mediastinum. The surgical resection was performed via video-assisted thoracic surgery. Surgery was performed using a vessel-sealing device; however, bleeding was persistent from the surrounding tissue. Total bleeding was 400 g. Blood pressure fluctuations and arrhythmia did not occur during the operation. The patient’s uncontrolled diabetes was cured after the surgery, and the tumor was diagnosed as a functional paraganglioma. Conclusions We encountered a rare case of functional paraganglioma located in the middle mediastinum. Functional paragangliomas should be considered as a potential cause of uncontrolled diabetes, and a whole-body CT scan should be performed to investigate this possible cause.

Resection of a Giant Middel Mediastinum Paraganglioma by Clamshell Incision without Cardiopulmonary Bypass

“…Biological examinations: The most often performed biological test is the measurement of metanephrines in the blood and/or in the urine for 24 hours [1-3, 9, 11-12, 16]; it reflects the secretion of catecholamines. A test for chromogranin a practiced in the blood as well as the verification of the potassium level and the glycemia complete the biological assessment [1,16].…”

“…Currently, the diagnosis of paraganglioma is complicated on a biopsy [3,8,16,19,22]. It requires a complete structural and morphological pathologic tumor analysis [3,8].…”

“…Significant technical difficulties related to the lesion location and the vascular, respiratory, and nervous structures proximity may be shown. In functional paraganglioma, arteriography with embolization can be performed not only to avoid major intraoperatively bleeding and to reduce catecholaminergic discharges but also to visualize preoperatively the tumor vascularization [3,13,16].…”

“…Depending on the locally tumor invasion, an aortic transection may be practiced and the resection of one of more accessory thoracic vessels or the left atrium is sometimes performed with vascular or cardiac reconstruction. In the most often situations, sternotomy allows the mobilization of the aorta, the pulmonary artery, and the main airways to have a good exposure and a secure a bloc resection of the lesion [9,12,14,16,[25][26][27].…”

“…Depending on limited size, favorable location, and obviously free relations, lesion may sometimes be resected with a videoassisted procedure, but it remains, always, significant bleeding or nerve damage risk. Open surgery will often be preferred to offer better control of potential bleeding and to perform a bloc resection with negative margins [3,12,16,18].…”