Clinical and genetic features of pediatric PCCs/PGLs patients: a single-center experience in China

Left lateral-aortic paraganglioma in an adolescent: A rare case report

INTRODUCTION

Paraganglioma is a rare neuroendocrine tumor arising outside the adrenal gland from the primitive neural crest cells. The pediatric form is an exceptional entity.

CASE REPORT

Here we report a case of a 15-year-old boy presenting with hypertensive crisis. Computed tomography scan revealed a left lateral-aortic paraganglioma, with significantly elevated plasmatic catecholamine levels. Preoperative management was conducted in our patient with selective alpha-1 blockers, then complete resection of the tumor was achieved without complications. The histological and immunohistochemical examination confirmed the diagnosis of a paraganglioma.

DISCUSSION

Paranganglioma management should be started as soon as possible to prevent high blood pressure complications. It is based on preoperative medication with alpha-blocker to prevent adrenegeric discharge, followed by a complete and safe surgical removal of the tumor.

CONCLUSION

Functional paraganglioma remains a rare entity among pediatric population. Preoperative management is mandatory to avoid postoperative morbidity.

Surgical treatment of large pheochromocytoma (>6 cm): A 10-year single-center experience

Objective

Clinical practice guidelines recommend open adrenalectomy (OA) for large pheochromocytoma (LPCC) > 6 cm in size. Although laparoscopic adrenalectomy (LA) for the treatment of LPCC has been reported, its role remains unclear. This study aimed to compare the effectiveness of LA and OA, and summary the surgical treatment experience.

Methods

Data concerning LPCC, from January 2010 to June 2019 of a single institution, were retrospectively reviewed. Altogether 82 patients with a tumor larger than 6 cm were included (52 patients in LA group and 30 patients in OA group). Groups were balanced by propensity score matching (PSM) into 15 pairs. Patients’ demographics, preoperative characteristics, and prognosis were analyzed.

Results

Before PSM, the OA group had larger tumor sizes (median [interquartile range, IQR]: 8.9 [7.3–10.3] vs. 7.2 [6.7–8.0] cm; p=0.000) and higher vanillylmandelic acid level (median [IQR]: 114.3 [67.8–326.4] vs. 66.6 [37.8–145.8] μmol/24 h; p =0.004) and needed a higher cumulative dose of prazosin (median [IQR]: 83.5 [37.0–154.0] vs. 38.0 [21.0–81.0] mg; p=0.028). After PSM, the baseline data showed no significant differences between both groups. The LA group had relatively more stable blood pressure in surgery, with a lower fluctuation of systolic blood pressure (mean±standard deviation [SD]: 70.9±25.1 vs. 107.4±46.2 mmHg, p=0.012) and a lower percentage of hemodynamic instability (46.7% vs. 86.7%, p=0.020). The LA group had shorter postoperative hospital stays (mean±SD: 6.4±2.7 vs. 10.1±3.4 days; p=0.003) than the OA group. Differences regarding metastasis rate (6.7% vs. 0, p=1.000) were not statistically significant between LA and OA groups. The median (IQR) follow-up time of 82 patients was 72.5 (47.0–103.5) months. Binary logistic regression showed that right-side tumors or those >8 cm in size were independent risk factors of OA.

Conclusion

LA is a safe, minimally invasive procedure for LPCC and has relatively better perioperative characteristics in large medical centers. Patients with tumors on the right side or larger than 8 cm are more likely to undergo OA initially.