A young patient with heart failure was diagnosed with extra-adrenal paraganglioma: a case report

BACKGROUND

We present a case of pelvic paraganglioma that presented with heart failure as the primary symptom.

CASE PRESENTATION

A 35-year-old man was admitted to hospital due to heart failure. Contrast-enhanced pelvic CT showed mass shadows in the posterior wall of the bladder and multiple enlarged lymph nodes in the retroperitoneal area. Ultrasound-guided puncture was performed, and the pathologic diagnosis was extra-adrenal paraganglioma. The patient refused any chemotherapy and died within six months of diagnosis.

CONCLUSION

The possibility of neuroendocrine-related tumors, for example paragangliomas, should be considered in young patients with heart failure, especially those with concomitant hypertension and diabetes.

Imaging features of retroperitoneal extra-adrenal paragangliomas in 10 dogs

Retroperitoneal paragangliomas are rare tumors of the neuroendocrine system. Only a few canine case reports are available with rare descriptions of their imaging features. The objectives of this multi‐center, retrospective case series study were to describe the diagnostic imaging features of confirmed retroperitoneal paragangliomas and specify their location. Medical records and imaging studies of 10 affected dogs with cytological or histopathologic results concordant with retroperitoneal paragangliomas were evaluated. Dogs had a median age of 9 years. Four of them had clinical signs and laboratory reports compatible with excessive production of catecholamines. Six ultrasound, four CT, four radiographic, and one MRI studies were included. The paragangliomas did not have a specific location along the aorta. They were of various sizes (median 33 mm, range: 9–85 mm of length). Masses had heterogeneous parenchyma in six of 10 dogs, regardless of the imaging modality. Strong contrast enhancement was found in all CT studies. Encircling of at least one vessel was detected in six of 10 masses, clear invasion of a vessel was identified in one of 10 masses. In five of 10 cases, the masses were initially misconstrued as lymph nodes by the on‐site radiologist. Retroperitoneal paragangliomas appear along the abdominal aorta, often presenting heterogeneous parenchyma, possibly affecting the local vasculature, and displaying strong contrast enhancement on CT. Clinical signs can be secondary to mass effects or excessive catecholamine production. Underdiagnosis and misdiagnosis of this tumor are suspected as they can be silent, of small size, or confused with other structures.

Carney-Stratakis syndrome: A dyad of familial paraganglioma and gastrointestinal stromal tumor

Carney-Stratakis syndrome is a rare, distinct dyad of familial paraganglioma and gastrointestinal stromal tumor, and is associated with germline mutations in the succinate dehydrogenase genes SDHB, SDHC, and SDHD. We present a unique case of a 45-year-old woman with Carney-Stratakis syndrome who initially presented with a palpable left neck mass. Further workup demonstrated 2 paragangliomas in the neck and multiple SDHB deficient gastrointestinal stromal tumors of the stomach. We describe the imaging findings and clinical course of this rare syndrome.

Imaging and Screening of Hereditary Cancer Syndromes

There is a wide spectrum of mendelian disorders that predispose patients to an increased risk of benign as well as malignant tumors. Hereditary cancer syndromes are characterized by the early onset of diverse, frequently advanced malignancies in specific organ systems in multiple family members, posing significant challenges to diagnosis and management. A better understanding of the genetic abnormalities and pathophysiology that underlie these disorders has led to contemporary paradigms to screen, allowing early diagnosis, and has improved targeted therapies to aid in management. This article reviews select hereditary cancer syndromes with an emphasis on imaging-based screening and surveillance strategies.

Images of pheochromocytoma in adrenal glands

Pheochromocytomas are relatively rare tumors of the adrenal medulla. A wide spectrum of imaging findings has been described. The aim of this article is to describe the multimodality imaging features of pheochromocytomas including diagnostic pearls that can help differentiate them from other adrenal lesions and pitfalls to avoid.

Hypervascular mediastinal masses: action points for radiologists

Hypervascular mediastinal masses are a distinct group of rare diseases that include a subset of benign and malignant entities. Characteristic features and known association with syndromes and genetic mutations assist in achieving a diagnosis. Imaging allows an understanding of the vascularity of the lesion and should alert the radiologist and clinician to potential hemorrhagic complications and avoid percutaneous CT guided biopsies. In such cases, pre-procedure embolization and surgical biopsy maybe considered for better control of post procedure hemorrhage. The purpose of this article is to describe and illustrate the clinical features and radiologic spectrum of hypervascular mediastinal masses, and discuss the associated clinical and genetic syndromes. We will present an imaging algorithm to determine further evaluation and subsequently guide treatment.

Primary malignant tumors of peritoneal and retroperitoneal origin: clinical and imaging features

Peritoneal carcinomatosis and metastatic involvement of the retroperitoneum are manifestations of many organ-based malignancies and lymphoproliferative disorders. Primary malignancies of peritoneal and retroperitoneal origin occur much less frequently, and are difficult to distinguish from metastatic disease on imaging alone. However, the imaging features of these primary tumors, taken in concert with the clinical data, can be helpful in narrowing the scope of the differential diagnosis. This review presents the clinical and imaging features of primary peritoneal and retroperitoneal tumors arising from the various tissue components that comprise the ligaments, mesenteries, and connective tissues of the peritoneal and retroperitoneal spaces.

Multimodality imaging findings of pheochromocytoma with associated clinical and biochemical features in 53 patients with histologically confirmed tumors

OBJECTIVE

The purpose of this study was to determine the spectrum of imaging appearances of pheochromocytoma and the associated clinical and biochemical features.

MATERIALS AND METHODS

In this retrospective study, a citywide pathology database (2000-2011) was searched to identify the records of patients with pheochromocytoma. The search yielded the cases of 53 patients (28 men, 25 women; mean age, 50 years). The institutional PACS and radiology information system records, hospital charts, and the provincial electronic health records of these patients were reviewed. Imaging appearances and clinical and biochemical features related to pheochromocytomas were recorded.

RESULTS

One chart was not available for review. In the 52 cases analyzed, 40 of the patients had symptoms: 31 patients had hypertension; 10 had the triad of palpitations, diaphoresis, and headaches; and all had elevated urinary metanephrine concentrations. Seven patients had a familial syndrome, and five had bilateral pheochromocytomas. One patient had an extraadrenal pheochromocytoma, and five had malignant tumors. The mean size of pheochromocytomas was 4.0 cm. Most pheochromocytomas were heterogeneous (CT, 56%; MRI, 65%; ultrasound, 45%) and were MIBG positive (90%). Eleven of 34 (32%) pheochromocytomas had T2 signal intensity greater than that of the spleen. Most pheochromocytomas were less enhancing than the spleen (CT, 85%; MRI, 71%). Contrast-enhanced CT was performed on 33 tumors, of which 20 enhanced less than the spleen and 8 showed similar enhancement to the spleen; contrast-enhanced MRI was performed on 24 tumors, of which 12 enhanced less than the spleen and 5 showed similar enhancement to the spleen. Predominant cystic change was found in 4 of 20 (20%) ultrasound, 9 of 41 (22%) CT, and 11 of 34 (32%) MRI examinations. Eight of 34 (24%) pheochromocytomas were hemorrhagic, two (5%) had calcifications, and three of six were PET positive. Two cystic pheochromocytomas and one lipid-containing pheochromocytoma were misdiagnosed as adrenal adenomas.

CONCLUSION

Most pheochromocytomas were heterogeneous at imaging, were MIBG positive, accompanied elevated urinary metanephrine concentrations, and were symptomatic. High T2 signal intensity was found in approximately one third of solid tumors. Atypical imaging features included homogeneity, cystic change, hemorrhage, intense enhancement, calcifications, intracellular lipid, bilaterality, and malignancy.