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Preoperative Diagnosis of Abdominal Extra-Adrenal Paragangliomas with Fine-Needle Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12081819. [PMID: 36010170 PMCID: PMC9406649 DOI: 10.3390/diagnostics12081819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Paragangliomas are rare, non-epithelial neuroendocrine neoplasms originating in paraganglia, for instance the adrenal medulla, or at extra-adrenal locations. The aim of this study was to review the literature regarding abdominal extra-adrenal paragangliomas diagnosed pre-operatively with fine-needle biopsy (FNA and/or FNB). The PubMed database was searched to identify such cases, using a specific algorithm and inclusion/exclusion criteria. An unpublished case from our practice was also added to the rest of the data, resulting in a total of 36 cases for analysis. Overall, 24 (67%) lesions were found in females, whereas 12 (33%) in males. Most (21/36; 58.33%) were identified around and/or within the pancreatic parenchyma. FNA and/or FNB reached or suggested a paraganglioma diagnosis in 17/36 cases (47.22%). Of the preoperative misdiagnoses, the most common was an epithelial neuroendocrine tumor (NET). Regarding follow-up, most patients were alive with no reported recurrence; however, 5/36 patients exhibited a recurrence or a widespread disease, whereas one patient died 48 months following her diagnosis. In two patients, transient hypertension was reported during the EUS-FNA procedure. In conclusion, this study showed that the preoperative diagnosis of these lesions is feasible and, while diagnostic pitfalls exist, they could significantly be avoided with the application of immunochemistry.
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Matsuzawa N, Nishikawa T, Ohno R, Inoue M, Nishimura Y, Okamoto T, Shimizu T, Shinagawa T, Nishizawa Y, Kazama S. Paraganglioma of the urinary bladder initially diagnosed as gastrointestinal stromal tumor requiring combined resection of the rectum: a case report. World J Surg Oncol 2022; 20:185. [PMID: 35676716 PMCID: PMC9178902 DOI: 10.1186/s12957-022-02662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Paraganglioma of the urinary bladder (Pub) is rare and presents with clinical symptoms caused by catecholamine production and release. The typical symptoms of Pub are hypertension, macroscopic hematuria, and a hypertensive crisis during micturition. The average size of detected Pubs is approximately 3 cm. Herein, we report a case of a large Pub in which the symptoms were masked by oral medication, precise preoperative diagnosis was difficult, and intraoperative confirmation of tumoral adhesion to the rectum resulted in hypertensive attacks during surgery. Case presentation A 64-year-old Japanese male with a history of hypertension and arrhythmia controlled with oral medication presented with a large tumor in the pelvic region, detected on examination for weight loss, with no clinical symptoms. Computed tomography and magnetic resonance imaging revealed a tumor measuring 77 mm in diameter in the posterior wall of the urinary bladder. The border with the rectum was unclear, and the tumor showed heterogeneous enhancement in the solid part with an enhancing hypodense lesion. Cystoscopy revealed compression of the bladder trigone by external masses; however, no tumor was visible in the lumen. Endoscopic ultrasonography-guided fine-needle aspiration revealed CD34-positive spindle-shaped cells in the fibrous tissue, suggestive of a mesenchymal neoplasm. The tumor was suspected to be a gastrointestinal stromal tumor, and surgery was performed. After laparotomy, we suspected that the tumor had invaded the rectum, and total cystectomy and anterior resection of the rectum were performed. Histologically, the tumor cells had granular or clear amphophilic cytoplasm with an oval nucleus and nests of cells delimited by connective tissue and vascular septations. Immunohistochemically, the tumor was positive for chromogranin A, CD56, and synaptophysin, and a diagnosis of paraganglioma of the urinary bladder was confirmed. There was no tumor recurrence at the 7-month follow-up. Conclusion This case highlights the importance of careful examination of pelvic tumors, including endocrine testing, for detecting paraganglioma of the urinary bladder in patients with a history of hypertension or arrhythmia.
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Affiliation(s)
- Natsumi Matsuzawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan.
| | - Takeshi Nishikawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Riki Ohno
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Cancer Center, Saitama, Japan
| | - Yu Nishimura
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
| | - Tomomi Okamoto
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Takao Shimizu
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Takahide Shinagawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Yusuke Nishizawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Shinsuke Kazama
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
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Martin-Cardona A, Fernandez-Esparrach G, Subtil JC, Iglesias-Garcia J, Garcia-Guix M, Barturen Barroso A, Gimeno-Garcia AZ, Esteban JM, Pardo Balteiro A, Velasco-Guardado A, Vazquez-Sequeiros E, Loras C, Martinez-Moreno B, Castellot A, Huertas C, Martinez-Lapiedra M, Sanchez-Yague A, Teran A, Morales-Alvarado VJ, Betes M, de la Iglesia D, Sánchez-Montes C, Lozano MD, Lariño-Noia J, Gines A, Tebe C, Gornals JB. EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study. PLoS One 2019; 14:e0216658. [PMID: 31170163 PMCID: PMC6553722 DOI: 10.1371/journal.pone.0216658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. Methods This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist’s suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. Results A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16–4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1–3.9), variegated AG shape (OR2.46; 95%CI, 1–6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2–58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. Conclusions EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.
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Affiliation(s)
- A Martin-Cardona
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain
| | - G Fernandez-Esparrach
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - J C Subtil
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - J Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - M Garcia-Guix
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - A Barturen Barroso
- Department of Digestive Diseases, Hospital Universitario Cruces, Bilbao, Spain
| | - A Z Gimeno-Garcia
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - J M Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - A Pardo Balteiro
- Department of Digestive Diseases, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - A Velasco-Guardado
- Department of Digestive Diseases, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - E Vazquez-Sequeiros
- Endoscopy unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - C Loras
- Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - B Martinez-Moreno
- Department of Digestive Diseases, Hospital General Universitario de Alicante, Alicante, Spain
| | - A Castellot
- Department of Digestive Diseases, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - C Huertas
- Department of Digestive Diseases, Hospital Dr. Josep Trueta Girona, Girona, Spain
| | | | | | - A Teran
- Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - V J Morales-Alvarado
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Betes
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - D de la Iglesia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - C Sánchez-Montes
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M D Lozano
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - J Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - A Gines
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - C Tebe
- Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Gómez Espín R, López Martín A, Esteban Delgado P, Fuente García E, Ortega GonzálezI I, López Higueras A, Alcazar E, Herranz MT. [Abdominal paraganglioma. Endoscopic ultrasound as a new diagnostic tool]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 38:498-500. [PMID: 25300232 DOI: 10.1016/j.gastrohep.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Rosa Gómez Espín
- Unidad asistencial de Aparato Digestivo, Hospital Morales Meseguer, Murcia, España.
| | - Aurelio López Martín
- Unidad asistencial de Aparato Digestivo, Hospital Morales Meseguer, Murcia, España
| | | | - Eliana Fuente García
- Unidad asistencial de Aparato Digestivo, Hospital Morales Meseguer, Murcia, España
| | | | | | - Eduardo Alcazar
- Servicio de Anatomía Patológica, Hospital Morales Meseguer, Murcia, España
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Sharma SS, Jhajharia A, Maharshi S, Ram S, Shankar V, Katiar P. Mediastinal paraganglioma: specific endoscopic ultrasound features. Endosc Ultrasound 2013; 2:105-6. [PMID: 24949374 PMCID: PMC4062241 DOI: 10.4103/2303-9027.117698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/10/2012] [Indexed: 11/04/2022] Open
Abstract
Endoscopic ultrasound (EUS) features of mediastinal paraganglioma have not been described. In this paper, we report a female patient presented with cough and chest pain without any neuroendocrinal symptoms. Final diagnosis of mediastinal paraganglioma was made on thoracoscopic biopsy and immunohistochemistry after EUS-guided fine needle aspiration. EUS features of mediastinal paraganglioma are described.
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Affiliation(s)
| | - Ashok Jhajharia
- Department of Gastroenterology, SMS Medical College, Jaipur, India
| | - Sudhir Maharshi
- Department of Gastroenterology, SMS Medical College, Jaipur, India
| | - Shewa Ram
- Department of Gastroenterology, SMS Medical College, Jaipur, India
| | - Vijay Shankar
- Department of Gastroenterology, SMS Medical College, Jaipur, India
| | - Prashant Katiar
- Department of Gastroenterology, SMS Medical College, Jaipur, India
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