Retro-peritoneal paraganglioma, diagnosis and management

Subclinical paraganglioma of the retroperitoneum: A case report

BACKGROUND

Paraganglioma (PGL) located in the retroperitoneum presents challenges in diagnosis and treatment due to its hidden location, lack of specific symptoms in the early stages, and absence of distinctive manifestations on imaging.

CASE SUMMARY

A 56-year-old woman presented with a left upper abdominal mass discovered 1 wk ago during a physical examination. She did not have a history of smoking, alcohol consumption, or other harmful habits, no surgical procedures or infectious diseases, and had a 4-year history of hypertension. Upon admission, she did not exhibit fever, vomiting, or abdominal distension. Physical examination indicated mild percussion pain in the left upper abdomen, with no palpable enlargement of the liver or spleen. Laboratory tests and tumor markers showed no significant abnormalities. Enhanced computed tomography and magnetic resonance imaging of the upper abdomen revealed a cystic solid mass in the left epigastrium measuring approximately 6.5 cm × 4.5 cm, with inhomogeneous enhancement in the arterial phase, closely associated with the lesser curvature of the stomach and the pancreas. The patient underwent laparoscopic resection of the retroperitoneal mass, which was successfully removed without tumor rupture. A 12-month postoperative follow-up period showed good recovery.

CONCLUSION

This case report details the successful laparoscopic resection of a retroperitoneal subclinical PGL, resulting in a good recovery observed at the 12-month follow-up. Interestingly, the patient also experienced unexpected cure of hypertensive disease.

An Analysis of Computed Tomography Imaging Features and Predictive Factors for Postoperative Recurrence and Metastasis of Abdominal Paragangliomas

Methods

We studied 51 abdominal PGL patients at the First Affiliated Hospital of Bengbu Medical College, Tongde Hospital, and Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China, from June 2009 to May 2019. Thereafter, the clinical research data, tumor biomarkers, and CT features were compared between the aggressive PGLs and the nonaggressive PGLs using independent-samples t-tests and chi-square tests.

Results

Of the 51 cases, 43 were benign and 8 had malignant tendencies. Postoperative recurrence and metastasis were more likely to occur when the tumor diameter was >8 cm or/and the enhancement degree was not obvious. Clinical symptoms, tumor markers, sex, age, and CT image characteristics including morphology, presence of cystic degeneration, "pointed peach" sign, calcification, hemorrhage, enlarged lymph nodes, and peritumor and intratumor blood vessels were not significantly different between the two groups (p > 0.05).

Conclusion

Our findings suggest that CT features, including size >8 cm and enhancement degree, could provide important evidence to assess risk factors for aggressive PGLs.

Preoperative Alpha-Blocker Therapy in Patients with Missed Preoperative Diagnosis of Extra-Adrenal Retroperitoneal Paraganglioma Undergoing Resection: A Retrospective Study of 167 Cases at a Single Center

INTRODUCTION

Preoperative α-adrenergic blockade is thought to decrease perioperative risks and mortality in surgeries for adrenal pheochromocytoma. However, there are limited data on the efficacy of α-blockers in surgeries for retroperitoneal paragangliomas. The aim of this study was to evaluate the effects of the preoperative α-adrenergic blockade on outcomes in patients undergoing surgery for extra-adrenal retroperitoneal paraganglioma.

METHODS

We searched the clinical database for patients diagnosed with extra-adrenal retroperitoneal paraganglioma by postoperative histopathology in the General Hospital of People's Liberation Army in China from 2000 to 2017. We compared the preoperative status of patients, preoperative examination, preoperative preparation, intraoperative and postoperative cardiovascular events, intake and output, length of stay in the intensive care unit, length of hospital stays, and short-term outcomes between patients who received preoperative treatment with α-adrenergic blockade and those who did not.

RESULTS

Of the 167 patients enrolled in the study, 61 received preoperative α-adrenergic blockade therapy. Intraoperative heart rate elevation and highest heart rate were higher in patients undergoing tumor manipulation with preoperative α-adrenergic blockade than those who did not (p < 0.05). However, there were no significant differences between these 2 groups in terms of intraoperative blood pressure elevation and systolic blood pressure decrease following tumorectomy (p > 0.05). Moreover, there were no significant differences in postoperative complications and outcomes (p > 0.05).

CONCLUSION

Under the current medical practice, resection of extra-adrenal retroperitoneal paraganglioma can be successfully carried out with or without preoperative α-adrenergic blockade.