Middle mediastinal paraganglioma enclosing the left anterior descending artery: A case report

Abstract

Rationale: Paragangliomas are extremely rare neuroendocrine tumors arising from ganglia. These tumors are barely found in the middle mediastinum.Patient Concerns: A 31-year-old male patient was admitted to our hospital for treatment of an middle mediastinal tumor which was found incidentally on echocardiography during a medical checkup. Contrast-enhanced chest computed tomography (CT) demonstrated a well-defined hypervascularized heterogeneous mass located in the middle mediastinum. The tumor showed strong 18F-fluorodeoxyglucose (FDG) activity on positron emission tomography-computed tomography (PET-CT).Diagnosis: Before the surgery, we presumed the mass was an angiogenic or neurogenic tumor. As a result, the histological features favored a diagnosis of paraganglioma. Interventions:The tumor was completely removed by anterior thoracotomy, along with the proximal segment of the left anterior descending artery (LAD), and coronary artery bypass grafting (CABG) was performed immediately after the tumor excision.Outcomes: The patient had an uneventful recovery. The patient did well in the postoperative follow-up without any complications and signs of recurrence at 3 months, 1 year, 2 year and 4 year.

Resection of a Giant Middel Mediastinum Paraganglioma by Clamshell Incision without Cardiopulmonary Bypass

“…The paragangliomas diagnosis and management are complex and require multidisciplinary competences. The diagnosis of paraganglioma is most often made by the analysis of the operative specimen removed during the surgical intervention or during biopsy on the histological aspect of the tumor and on the existence of specific markers such as chromogranin A (which can also be measured in blood) and sometimes synaptophysin [2,8,[13][14].…”

“…The diagnosis of malignancy is based on the demonstration of a relapse or an extension into the lymph nodes, tissues around the primary tumor or extension remote disease in organs such as liver, lung, bone [1][2][3]13].…”

“…Imaging exams: Imaging examinations aim to specify both location of the tumor (or tumors) and extension(s) to monitor its evolution [2,10,13,[17][18].…”

“…Internal hemorrhage and cystic components contribute to the heterogeneous MRI appearance of these tumors. Additional use of opposed phase imaging can be helpful as paragangliomas do not exhibit dropout of signal on opposed phase imaging, but adenomas do [1,6,10,13,18].…”

“…In case of functional paraganglioma causing refractory arterial hypertension,  and -adrenergic blockers or calcium channel blockers with increase in circulating volume by low molecular weight dextran and a salty diet are useful [1,3,13,25]. Catecholamines synthesis inhibition with Metyrosine can also be established [25].…”