Mediastinal paraganglioma fed by the left circumflex artery

González-Santos, José María; Arnáiz-García, María Elena; Muñoz-Herrera, Ángel; López-Rodríguez, Javier

doi:10.1093/icvts/ivw197

Cited by 10 publications

(12 citation statements)

References 5 publications

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“…An additional 2.5% mortality was reported for the immediate postoperative course. A review of individual case reports from 2014-2016, two years since Wang et al's review, shows no intraoperative mortality reported from 11 cases (12,18,19,(22)(23)(24)(25)(26)(27). Among these cases, one instance of intraoperative cardiac arrest occurred due to severe hemorrhage and one unexpected intraoperative circulatory collapse, however both ended with successful outcomes (24,26).…”

Section: Discussionmentioning

confidence: 99%

Unusual cardiac paraganglioma mimicking an atypical carcinoid tumor of the lung

et al. 2018

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We present a case of unusual cardiac paraganglioma (PG) initially misdiagnosed as atypical carcinoid tumor of the lung and discuss key clinical and pathologic characteristics that guide surgical management of these rare chromaffin cell tumors. A 64-year-old female with persistent cough and back pain was found to have a 4 cm × 3 cm mass abutting multiple cardiopulmonary structures. A biopsy was performed at an outside institution and pathology reported "atypical neuroendocrine carcinoma, consistent with carcinoid". The patient was transferred to our institution and pericardial resection with right pneumonectomy was performed to excise the tumor. Histology of the mass was that of PG with multiple ethanol embolizations. Immunohistochemical examination revealed that type I (chief) cells were positive for neuroendocrine markers (chromogranin A and synaptophysin), while type II (sustentacular) cells were positive for S100. There was no evidence of atypical carcinoid tumor in the lung. PG is an entity of chromaffin cell tumors that often affects the adrenal glands and carotid body. PG rarely occurs in the thoracic region, accounting for just 1-2% of all PG. Proper diagnosis of cardiac PG is challenging owing to its rare prevalence, subtle symptoms of presentation, and the neuroendocrine histopathological features it shares with atypical carcinoids. These tumors are typically benign and are best treated by surgical resection. Our report examines the approach to appropriate diagnosis of cardiac PG vs. atypical carcinoid, preoperative management, and surgical treatment by describing successful resection through thoracotomy without the use of cardiopulmonary bypass.

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Section: Discussionmentioning

confidence: 99%

Unusual cardiac paraganglioma mimicking an atypical carcinoid tumor of the lung

et al. 2018

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“…The clinical presentation of paragangliomas varies with tumor location, degree of tumor burden, and secretory functionality. Functional paragangliomas secrete excessive catecholamines resulting in a clinical presentation of paroxysmal hypertension, headache, sweating, and palpitations [ 3 , 7 ]. Non-functional paragangliomas typically present with symptoms such as dysphagia, angina, or dyspnea as a result of a compressive mass effect on adjacent structures [ 3 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Functional paragangliomas secrete excessive catecholamines resulting in a clinical presentation of paroxysmal hypertension, headache, sweating, and palpitations [ 3 , 7 ]. Non-functional paragangliomas typically present with symptoms such as dysphagia, angina, or dyspnea as a result of a compressive mass effect on adjacent structures [ 3 , 7 ]. Mediastinal paragangliomas are estimated to make up 0.3% of all mediastinal tumors and less than 2% of all paragangliomas [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Metastatic Malignant Paraganglioma: A Case Report and Review of Literature

2017

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Metastasis is a rare presentation of non-secretory paraganglioma. Consequently, there is no standard of care for the treatment of metastatic malignant paraganglioma. The most widely used chemotherapy regimen for non-resectable cases includes cyclophosphamide, vincristine, and dacarbazine (CVD). CVD has been previously studied with variable therapeutic response. However, yttrium-90 (Y90) radioembolization has not been previously studied in the treatment of hepatic metastasis in patients diagnosed with malignant paraganglioma. This case report follows the treatment of a patient with stage IV mediastinal paraganglioma with metastasis to the liver. Treatment consisted of the CVD chemotherapy regimen and Y90 radioembolization of the hepatic lesions. After 10 cycles of CVD, the tumor size has decreased from 6.0 × 8.8 to 5.5 × 3.0 × 3.4 cm on computed tomography scan. The prominent metastatic liver lesions responded after Y90 radioembolization of both the right and left hepatic arteries. The prominent right hepatic lobe lesion has decreased in size from 2.6 × 3.4 × 3.0 cm to 2.6 × 2.8 × 2.9 cm. The prominent left hepatic lobe lesion originally measuring 1.6 cm in diameter completely resolved on follow-up imaging studies. After completion of 12 cycles of chemotherapy, the most recent positron emission testing scan determined no evidence of disease regarding both the primary mass and the hepatic lesions. This study demonstrates the first case of combination chemotherapy and Y90 radioembolization with a complete response per response evaluation criteria in solid tumors criteria. The approaches toward diagnosis and treatment corresponding to this case of malignant metastatic paraganglioma are also reviewed in this study.

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“…AorticopulmonaryPGLofsuperiorandmiddlemediastinumoccursinpatientswithmeanageof49yearsand catecholaminesecretionisdetectedinonly3%ofcas-es.TheparavertebralPGLsofposteriormediastinum ariseinyoungerpatientswithameanageof29years andalmosthalfofthesetumorsarehormonallyactive [10,11].MediastinalPGLstendtoinvadetoneighboringorgans,thusbecominghardertoremove [12,13]. Posterolateral thoracotomy or median sternotomyrepresenttherecommendedsurgicalapproaches.Inacaseofgreatvesselingrowthorhighriskof bleeding, cardiopulmonary bypass may be required [9,14]. If there is a suspicion of functioning PGL, abiopsyorresectioncanbeperformedonlyafteralpha-adrenergicblockademedication,becausesurgery cancauseseverehypertensionfromcatechomalmine crisis.Duetotheunpredictablemalignantpotential of PGLs, radical surgical excision is highly recommended with subsequent careful follow-up to rule out delayed metastatic spread.…”

Section: Discussionmentioning

confidence: 99%