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Usmani S, Al Riyami K, Jain A, Selvakumar RJ, Jayakrishan VV. The Great Imitator: Pulmonary Paraganglioma Mimicking Pulmonary Metastasis of Breast Cancer on 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:e82-e84. [PMID: 38170907 DOI: 10.1097/rlu.0000000000005029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
ABSTRACT Primary pulmonary paragangliomas are rare neuroendocrine tumors and are often discovered incidentally as nonfunctioning masses. We report a case of 58-year-old woman recently diagnosed with multifocal right breast cancer and suspicious right axillary lymph nodes. 18 F-FDG PET/CT showed a well-defined marginated lesion in the lower lobe of the right lung with intense FDG uptake. Findings were suspicious for pulmonary metastases. CT-guided biopsy results were consistent with a paraganglioma. Paragangliomas can mimic metastases, especially if they are large or have a high degree of FDG uptake, and careful evaluation of imaging features and clinical findings can help differentiate these entities. Most of the time biopsy is necessary to confirm the diagnosis.
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Affiliation(s)
| | | | - Anjali Jain
- From the Departments of Radiology and Nuclear Medicine
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Warren BC, Bond T, Hessler R, Boldt J. Primary Paraganglioma of the Lung in an Asymptomatic Patient. Cureus 2022; 14:e25562. [PMID: 35784994 PMCID: PMC9247742 DOI: 10.7759/cureus.25562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/05/2022] Open
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Kuo MJM, Nazari MA, Jha A, Pacak K. Pediatric Metastatic Pheochromocytoma and Paraganglioma: Clinical Presentation and Diagnosis, Genetics, and Therapeutic Approaches. Front Endocrinol (Lausanne) 2022; 13:936178. [PMID: 35903274 PMCID: PMC9314859 DOI: 10.3389/fendo.2022.936178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 12/18/2022] Open
Abstract
Although pediatric pheochromocytomas and paragangliomas (PPGLs) are rare, they have important differences compared to those in adults. Unfortunately, without timely diagnosis and management, these tumors have a potentially devastating impact on pediatric patients. Pediatric PPGLs are more often extra-adrenal, multifocal/metastatic, and recurrent, likely due to these tumors being more commonly due to a genetic predisposition than in adults. This genetic risk results in disease manifestations at an earlier age giving these tumors time to advance before detection. In spite of these problematic features, advances in the molecular and biochemical characterization of PPGLs have heralded an age of increasingly personalized medicine. An understanding of the genetic basis for an individual patient's tumor provides insight into its natural history and can guide clinicians in management of this challenging disease. In pediatric PPGLs, mutations in genes related to pseudohypoxia are most commonly seen, including the von Hippel-Lindau gene (VHL) and succinate dehydrogenase subunit (SDHx) genes, with the highest risk for metastatic disease associated with variants in SDHB and SDHA. Such pathogenic variants are associated with a noradrenergic biochemical phenotype with resultant sustained catecholamine release and therefore persistent symptoms. This is in contrast to paroxysmal symptoms (e.g., episodic hypertension, palpitations, and diaphoresis/flushing) as seen in the adrenergic, or epinephrine-predominant, biochemical phenotype (due to episodic catecholamine release) that is commonly observed in adults. Additionally, PPGLs in children more often present with signs and symptoms of catecholamine excess. Therefore, children, adolescents, and young adults present differently from older adults (e.g., the prototypical presentation of palpitations, perspiration, and pounding headaches in the setting of an isolated adrenal mass). These presentations are a direct result of genetic determinants and highlight the need for pediatricians to recognize these differences in order to expedite appropriate evaluations, including genetic testing. Identification and familiarity with causative genes inform surveillance and treatment strategies to improve outcomes in pediatric patients with PPGL.
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Affiliation(s)
- Mickey J. M. Kuo
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Matthew A. Nazari
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Karel Pacak,
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Mazzucco A, Poirè E, Leporati A, Chiari M, Moneghini L, Ghilardi G, Baisi A. An Unusual Histology for a Lung Nodule: A Case Report of Primary Pulmonary Paraganglioma. Front Surg 2021; 8:688236. [PMID: 34222324 PMCID: PMC8249766 DOI: 10.3389/fsurg.2021.688236] [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: 03/30/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Primary pulmonary paraganglioma is a rare tumor with few cases reported in literature and unspecific clinical presentation. Case Presentation: A 49-year-old woman presented to our department with an incidental finding of a pulmonary mass at chest X-ray and no associated clinical symptom. The CT scan and the FDG-PET showed mild uptake of contrast, but a definitive diagnosis was only possible after surgery through histopathological examination. Conclusion: Paragangliomas originating in the pulmonary tissue are generally non-functioning masses discovered incidentally in otherwise asymptomatic patients. Surgery appears to be the best treatment option, with only radiologic follow-up necessary afterwards.
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Affiliation(s)
- Alessandra Mazzucco
- Thoracic Surgery Unit, University of Milan-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Eleonora Poirè
- Thoracic Surgery Unit, University of Milan-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Andrea Leporati
- Thoracic Surgery Unit, University of Milan-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Matteo Chiari
- Thoracic Surgery Unit, University of Milan-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Laura Moneghini
- Unit of Anatomical Pathology-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Giorgio Ghilardi
- Thoracic Surgery Unit, University of Milan-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Alessandro Baisi
- Thoracic Surgery Unit, University of Milan-Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
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Huang XJ, Wu C, Chen XY. Primary endobronchial paraganglioma with lymph node metastasis: a case report. J Int Med Res 2021; 49:3000605211003014. [PMID: 33771069 PMCID: PMC8166387 DOI: 10.1177/03000605211003014] [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] [Indexed: 11/15/2022] Open
Abstract
A paraganglioma is an extra-adrenal tumor of the paraganglia often found in association with sympathetic and parasympathetic nerves. A primary pulmonary paraganglioma generally presents as multiple small tumors or a solitary mass; however, endobronchial involvement is extremely rare. A 49-year-old man was admitted to our hospital because of a chronic cough, intermittent dyspnea, and chest pain. Chest computed tomography revealed a rounded, high-density lesion in the left lower lung lobe. Fiberoptic bronchoscopy demonstrated an endobronchial mass characterized by smooth, hypervascularized mucosa. Transbronchial biopsy of the mass and immunohistochemistry results suggested a paraganglioma. The patient fully recovered after lobectomy and lymphadenectomy. Pulmonary paragangliomas are rarely reported. Complete surgical resection is considered the treatment of choice for pulmonary paragangliomas, and the long-term prognosis is generally good. However, life-long follow-up is mandatory because of the possibility of recurrence and metastasis. This case report adds valuable knowledge to the literature on pulmonary paragangliomas.
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Affiliation(s)
- Xiao-Jun Huang
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, China
| | - Chengxiang Wu
- Department of Respiratory Medicine, Pujiang County Hospital of Traditional Chinese Medicine of Zhejiang Province, Pujiang, China
| | - Xi-Yuan Chen
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, China
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Africa G, Plutino FM, Filotico M. A rare neurendocrine tumor of the lung: sclerosing paraganglioma. A neoplasm that is difficult to diagnose and a source of dangerous pitfalls. A case report and literature review. Pathologica 2021; 112:191-194. [PMID: 33393521 PMCID: PMC8183351 DOI: 10.32074/1591-951x-23-19] [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: 08/30/2019] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
An endobronchial obstructing neoformation was found in a 58-year-old man. The histology and immunohistochemical profile oriented the authors towards a diagnosis of paraganglioma, sclerosing variant. This very difficult diagnosis, especially in a pulmonary localization, may lead to erroneous conclusions both in terms of histogenetic interpretation and that of its biological behavior. The pulmonary localization of the paraganglioma is very rare and even more rare the sclerosing variant, recently reported. Differential diagnosis and literature are discussed.
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Affiliation(s)
- Giovanni Africa
- Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Francesca M Plutino
- Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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Tobón A, Velásquez M, Pérez B, Zúñiga V, Sua LF, Fernández-Trujillo L. Pathologic features and clinical course of a non-functioning primary pulmonary paraganglioma: A case report. Ann Med Surg (Lond) 2020; 55:185-189. [PMID: 32514340 PMCID: PMC7266998 DOI: 10.1016/j.amsu.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Paragangliomas (PGGL) are rare neuroendocrine tumors arising from non-epithelial extra-adrenal chromaffin cells. They have been described in different sites: abdomen, pelvis, head, neck and thorax. Incidence is very low, occurring in less than 2–8/million per year. PGGL's of the lung are extremely rare, they have a slow growth and present as painless lesions. Biopsy is the method of choice for diagnosis and prognosis. Presentation of case This is a 70-year-old woman with chronic cough, with a CT-scan showing a 3.3-cm mass in the left lower lobe. After video-assisted thoracic surgery, histologic findings confirmed a non-functioning pulmonary paraganglioma. We present the clinical, radiological, pathological findings and clinical course. Discussion Primary pulmonary PGGL's are extremely rare neuroendocrine tumors with low-grade malignancy, difficult to distinguish from other pulmonary tumors relying only on imaging techniques. In this case, PGGL presented as an incidentaloma during the evaluation of chronic cough. After histological diagnosis, genetic testing are ideally performed to identify somatic or germline mutations that may condition a higher risk of malignancy and metastasis. Conclusion PGGL's must be considered when other diagnoses are unlikely due to immunohistochemistry findings. Larger studies in this field are needed to determine the risk factors for its development and to determine which populations have the greatest potential for malignant transformation Paragangliomas are rare neuroendocrine tumors derived from non-epithelial extra-adrenal chromaffin cells. Paragangliomas from the lung are rare, they have a slow growth and present as non-painful lesions. Complete surgical resection is the diagnostic method of choice for solitary primary pulmonary paragangliomas. Genetic testing is important to identify somatic or germline mutations.
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Affiliation(s)
- Angélica Tobón
- Faculty of Health Sciences, Department of Internal Medicine, Universidad Icesi, Cali, Colombia
| | - Mauricio Velásquez
- Department of Surgery, Thoracic Surgery Service, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Department of Internal Medicine, Universidad Icesi, Cali, Colombia
| | - Bladimir Pérez
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Department of Internal Medicine, Universidad Icesi, Cali, Colombia
| | - Valeria Zúñiga
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - Luz F Sua
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Department of Internal Medicine, Universidad Icesi, Cali, Colombia
| | - Liliana Fernández-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Department of Internal Medicine, Universidad Icesi, Cali, Colombia
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Abstract
Primary pulmonary paraganglioma is a rare type of extra-adrenal paragangliomas arising from neuroectodermal-derived paraganglionic tissue. We report herein the case of a 49-year-old woman with a round-like well-defined nodule in the right middle lobe detected by chest CT. FDG PET/CT also revealed this homogeneous nodule with increased FDG accumulation. Finally, the patient underwent right middle lobe resection, and the pathological findings demonstrated the diagnosis of pulmonary paraganglioma.
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Abstract
BACKGROUND Clear cell tumor of the lung (CCTL) is a rare and mostly benign pulmonary tumor arising from perivascular epithelioid cells. We reported 2 cases of CCTL in a 24-year-old man with chest pain and a 59-year-old man with dyspnea. METHODS Their chest CT images revealed a well-defined, homogeneous nodule located in the peripheral region of lung parenchyma. The solid nodule showed intense heterogenous postcontrast enhancement in the arterial phase and a homogenous appearance in the venous phase. The two patients underwent thoracotomy, and pathological examinations, including immunohistochemical studies revealed that both cases were benign clear cell tumors. RESULTS Due to the fact that only a few cases about CCTL were reported, clinicopathological aspects and radiological characteristics of this type of tumor are not well established. CONCLUSION CCTL is a rare and benign primary tumor and majorly occurs in middle-aged and elder people. The finding of a small vessel extending along and partially wrapping up one side of the mass in the CT-enhanced images might be a helpful feature to differentiate CCTL from other lung neoplasms.
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Affiliation(s)
| | | | - Linlin Li
- Department of Pathology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, P.R. China
| | - Kai Xu
- Department of Radiology
- Correspondence: Kai Xu, Department of Radiology, Affiliated Hospital of Xuzhou Medical University, No. 99 West Huai-hai Road, Xuzhou, Jiangsu, 221002, P.R. China (e-mail: )
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Huang X, Liang QL, Jiang L, Liu QL, Ou WT, Li DH, Zhang HJ, Yuan GL. Primary Pulmonary Paraganglioma: A Case Report and Review of Literature. Medicine (Baltimore) 2015; 94:e1271. [PMID: 26252294 PMCID: PMC4616580 DOI: 10.1097/md.0000000000001271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Primary pulmonary paraganglioma is a rare disease. We report a case of a 37-year old female patient with space-occupying lesions in the right lower pulmonary lobe during a routine examination without any symptoms. The patient underwent video-assisted thoracoscopic surgery (VATS) resection of the right middle lobe and dissection of hilar and mediastinal lymph nodes under general anesthesia. She recovered without recrudescence. Preoperative diagnosis is difficult. Accurate diagnosis requires pathological examination, and immunohistochemical test is particularly important. Complete resection is the first treatment option for solitary primary pulmonary paraganglioma; however, VATS is a better technique. Given the high local control rates and few complications of radiotherapy, it is considered as a standard treatment.
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Affiliation(s)
- Xin Huang
- From the Oncology Center, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
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