Nonfunctioning Paraganglioma Research Articles

Anesthesia Management of Two Operations for Nonfunctional Bladder Paraganglioma

Nonfunctional paragangliomas are perioperatively hemodynamically unstable and prone to lethal complications, making anesthesia a high surgical risk. We report the perioperative management of an unanticipated paraganglioma of the bladder over two surgical procedures. The patient developed a hypertensive crisis during the first intraoperative electrodesiccation of the tumor, and the surgeon stopped the operation and sent intraoperative cryopreservation, which was considered a paraganglioma of the bladder. Postoperative histopathological and immunohistochemical results confirmed the case as a paraganglioma of the bladder. Because of the high risk of continuing the surgery, a second surgery was performed after perfecting the preoperative preparation. The patient’s vital signs were stable during the second surgery and the patient’s prognosis was good after the surgery. An unanticipated intraoperative paraganglioma is a major perioperative challenge for anesthesiologists, and the improvement of its outcome is mainly due to good preoperative preparation, intraoperative hemodynamic monitoring, and the application of rapid, potent, and short-acting vasoactive drugs.

FRI227 Functional Transformation Of An Initially Non-functional Paraganglioma In A Patient With Cyanotic Congenital Heart Disease

Abstract Disclosure: M. McConnell: None. M. Kanin: None. M.S. Auerbach: None. R. Yu: None. Background: Most pheochromocytomas and about half of paragangliomas (P-PGLs) are functional in that they produce catecholamines. Transformation of non-functional to functional P-PGLs is exceedingly rare. We present a case of such transformation in a young male with cyanotic congenital heart disease (CCHD), resulting in catecholamine-induced cardiomyopathy. Clinical Case: A 27-year-old male with CCHD presented to the hospital with tachycardia, hypertension, and hypoxia. He had a newly depressed ejection fraction of <20% and was in florid heart failure. Despite intervention, he decompensated rapidly, requiring extracorporeal membrane oxygenation (ECMO). Five years prior to this presentation, he had had normal 24-hour urine fractionated metanephrines, vanillylmandelic acid (VMA), and homovanillic acid (HVA) levels; on imaging, he had been incidentally found to harbor a 3.3 x 1.6 x 2.5-cm nodule in the upper aortocaval space which could represent a paraganglioma. Subsequent imaging showed slow growth of this mass. Given this pertinent history, urine and plasma free metanephrine studies were repeated during the hospitalization while he was not on vasopressors. 24-hour urine normetanephrines were elevated at 2,644 mcg/d (81-667 mcg/d), metanephrines at 405 mcg/d (55-320 mcg/d) while plasma free metanephrines were elevated at 0.92 nmol/L (0-0.49 nmol/L) and normetanephrines at 11.85 nmol/L (0-0.89 nmol/L). DOTATATE PET/CT revealed a soft tissue mass measuring 4.3 x 3.1 x 4.9 cm with intense DOTATATE activity in the right paravertebral space between the aorta and cava. He was treated with alpha-adrenergic blockade with improvement in blood pressure. Two months later, he underwent resection of the mass with pathology confirming a 4.9 cm paraganglioma. Conclusion: It is very rare for a paraganglioma to undergo transformation from non-functional to functional status although it is reported in the literature. This scenario is supported by our patient’s normal 24-hour urine metanephrines, VMA, and HVA results on initial presentation followed by marked elevation in urine and plasma metanephrines 5 years later when he presented with heart failure. The functional transformation in this patient was accompanied by significant growth of the paraganglioma. We surmise that alterations in gene expression during tumor growth may be responsible for the functional transformation. It is crucial to reassess the functionality of a paraganglioma if the clinical condition suggests catecholamine excess. Presentation: Friday, June 16, 2023

Abdominal nonfunctional paraganglioma in which succinate dehydrogenase subunit B (SDHB) immunostaining was performed: a case report

BackgroundAbdominal nonfunctional paraganglioma is rare. Malignant potential of paraganglioma is assessed by Grading of Adrenal Pheochromocytoma and Paraganglioma score and genetic testing, but genetic testing is not common. We present a case of abdominal nonfunctional paraganglioma whose malignant potential was assessed by grading of adrenal pheochromocytoma and paraganglioma score and succinate dehydrogenase subunit B staining alternative to genetic testing.Case presentationA 39-year-old Japanese man had a right retroperitoneal tumor without symptoms. Uptake in the tumor was shown by 123I-meta-iodobenzylguanidine scintigraphy. There were no metastases. The results of biochemical workups including blood hormones and urinary metanephrines were normal. We performed retroperitoneoscopic surgery. The tumor was positive for chromogranin A staining but negative for tyrosine hydroxylase. On the basis of the preoperative biochemical workups and pathology results, we diagnosed the tumor as nonfunctional paraganglioma. The Grading of Adrenal Pheochromocytoma and Paraganglioma score classified the tumor as moderately differentiated. Furthermore, negative succinate dehydrogenase subunit B staining suggested the patient has the SDHx (SDHA, SDHB, SDHC and SDHD) mutation.ConclusionAbdominal nonfunctional PGLs are associated with SDHB mutation, and SDHB staining should be performed as a screening.

A Case of Non-functioning Paraganglioma – A Rare Phenomena

Non-functioning paragangliomas are rare tumors. I describe a case of a 74-year-old woman who presented with worsening neck mass and subsequently discovered to have a non-functioning paraganglioma after surgical resection. These tumors are associated with paraneoplastic diseases including MEN Syndromes, Neurofibromatosis and Von Hippel Lindau. Patients should be referred for genetic counseling once diagnosis is established.

A case of cervico-mediastinal paraganglioma mimicking an ectopic goiter.

Introduction and importanceMediastinal paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal paraganglia, occasionally secreting catecholamines. Nonfunctional mediastinal paragangliomas present nonspecific clinical and radiological features and represent a diagnostic challenge.Case presentationA 53-year old woman presented with cough and dyspnea increasing over time. CT-scan and ultrasonography showed a large vascularized cervico-mediastinal mass, consistent with an intrathoracic ectopic goiter. Preoperative angiography showed a blood supply from neck vessels. The lesion was completely removed through a cervical approach. The diagnosis of paraganglioma was a histological surprise. The patient is alive without recurrence 30 months after surgery.Clinical discussionWhen preoperatively diagnosed, the treatment of choice of a mediastinal paraganglioma is surgical excision. However, a preoperative diagnosis of mediastinal paraganglioma is difficult to obtain, especially in cases of nonfunctional lesions. Distinction between an intrathoracic goiter and a nonfunctional paraganglioma can be extremely difficult and, given the rarity of the latter, an ectopic goiter is suspected in first instance. CT-scan and ultrasonography are of little use in the differential diagnosis. However, scintigraphy with 123I-metaiodobenzylguanidine can be an useful diagnostic tool when a paraganglioma is suspected. In case of vascularized cervico-mediastinal mass, such as paragangliomas or intrathoracic goiter, preoperative angiography should be performed to study the blood supply and orient the surgical approach.ConclusionAlthough uncommon, paragangliomas should be considered in the differential diagnosis of mediastinal masses, especially when an ectopic goiter is suspected.

Incidental diagnosis of nonfunctional bladder paraganglioma: a case report and literature review

BackgroundNonfunctional bladder paragangliomas is a rare urological disease. It may present clinical, radiology and pathological features similar to bladder cancer, Only scarce reports have been reported. Urologist must identify this generally benign neuroendocrine neoplasm to avoid misdiagnosis.Case presentation A 62-year-old female presented the outpatient department of our hospital with the symptoms of stomachache, frequent micturition, and urination pain for 20 days. Diagnosed with high blood pressure 1 year ago, administered Amlodipine besylate tablets 5 mg po qd occasionally, did not check blood pressure; denied any tumor observation in the family history. Color ultrasound of the urinary system showed a 38 mm × 34 mm hypoechoic mass on the right side of the bladder, CDFI: in the masses, blood supply was sufficient. Cystoscope showed bladder occupying lesion. Biopsy diagnosis: papillary polypoid cystitis was suspected as a malignant change (Fig. 3a). Then, the patient was admitted to our urological department. Further, computer tomography urography considered bladder cancer. Cystoscopy and biopsy failed to define the nature of the lesions in our outpatient department, which prompted a transurethral resection of the bladder tumor. histopathological and immunohistochemical results were diagnosed as bladder paragangliomas. For the reason, the tumor was removed by partial resection of the bladder. The postoperative recovery and follow-up were uneventful.ConclusionsNonfunctional bladder paragangliomas are occasionally found on imaging studies with the symptoms of urinary tract infection or/and intermittent painless hematuria. It may present clinical, radiology and pathological features similar to bladder cancer, so knowledge of this generally benign neuroendocrine neoplasm is of great importance to avoid misdiagnosis. It should be accompanied by the clinical and pathological characteristics of the patient and image changes. Partial resection of the bladder can effectively treat this disease.

Incidentally Found Aorto-Pulmonary Middle Mediastinal Hypervascular Mass on Pulmonary CT Angiography in a Covid 19 patient

Paragangliomas (PGs) are rare neuroendocrine tumors arising from paraganglia, clusters of neuroendocrine cells scattered throughout the body. Mediastinal paragangliomas represent less than 2% of all paragangliomas and less than 0.3 % of the mediastinal tumors. These tumors may secrete catecholamines, however in up to 50% of cases they are nonfunctional and are diagnosed incidentaly or with symptoms of mass effcet to the adjacent structures. They should be considered in the differential diagnosis of hypervascular mediastinal masses. The typical radiological features are very guiding in the diagnosis and the management of the patient. We aimed to present a case of a hypervascular middle mediastinal mass incidentally found in a 69 year old woman and diagnosed with aortopulmonary nonfunctional PG radiologically.

SAT-LB306 A Case of Synchronous Non-Functioning Paraganglioma of the Urinary Bladder and Prostate Cancer

IntroductionThe bladder is an uncommon site for a paraganglioma, with only <1% of all paragangliomas occurring in the bladder. Management of non-functioning bladder paraganglioma is uncharted due to its rarity, and there is even less data for cases with synchronous malignancy. We found two case reports of synchronous paraganglioma and prostate cancer, only one in the bladder. Here we report a second case and discuss management.Clinical CaseA 72-year-old man with high risk prostate cancer, Grade group 5 on biopsy, was found to have a 1.2 x 1.6 cm bladder wall mass on staging CT scan. The transmural mass was only partially resectable via transurethral approach. Pathology unexpectedly revealed paraganglioma, confirmed by immunohistochemical stains for Synaptophysin, Chromogranin, and CD56.The patient had longstanding hypertension controlled on losartan and denied any symptoms of catecholamine excess. He had no family history of paraganglioma, pheochromocytoma, or related neoplastic syndrome. Plasma free metanephrine and normetanephrine levels were 57pg/mL (normal 57pg/mL) and 157pg/mL (normal 148pg/mL), respectively. Urinary studies were not performed due to stage 4 chronic kidney disease.Staging CT scan and bone scan did not show any other lesions. Even in cases of known distant metastases of paraganglioma, surgical resection of all tissue is recommended if possible. Thus, he underwent radical prostatectomy, bilateral pelvic lymphadenectomy and partial cystectomy. Prostate cancer was downgraded to Grade group 2, pT3aN0Mo and complete excision of the paraganglioma was confirmed.Evaluating for metastases and follow up are challenging in all paraganglioma cases, but especially non-functioning paragangliomas. Bladder paragangliomas carry a 10-15% risk of malignancy, but no separate data is reported for non-functioning ones. Histology scoring systems that are somewhat predictive in pheochromocytoma are less helpful in paragangliomas. Imaging is also challenging. CT, MRI, and a variety of functional imaging modalities have sensitivities for paraganglioma metastases in the range of 50 – 94% depending on location, functionality, and presence of germline mutation. For now, we recommend non-contrast CT with 18F-fluoro-2-deoxy-2-D-gluocse (FDG) PET. Though guidelines recommend annual biochemical surveillance, the usefulness in non-functioning paraganglioma is questionable.Genetic testing is recommended for all patients with paraganglioma. Succinate dehydrogenase B (SDHB) is most important given the propensity for metastases. Thus, we recommended the SDHx germline mutation package.Clinical LessonThis case is the second reported synchronous bladder paraganglioma and prostate cancer. It highlights the challenge, lack of data, and need for advancement in our knowledge for the best management of incidental, non-functioning, extra-adrenal paragangliomas.

MON-249 SDHD Mutation: Nonfunctional Paragangliomas Presenting as Bilateral Carotid Body Tumors with Syncope

SDHD Mutation: Nonfunctional paragangliomas presenting as bilateral carotid body tumors with syncopeBackground:A mutation of the SDHD gene is associated with hereditary paraganglioma-pheochromocytoma (PGL/PCC) syndromes which most commonly originate in the head and neck region, and usually form in the carotid body. Paragangliomas (PGL) can be secretory or non-secretory with about 95% of head and neck PGL being non-secretory. They can rarely present with symptoms due to compression, however, as in this case of a 29 year-old female presenting with syncope.Clinical Case:A 29 year-old female presented for evaluation after syncope. She had a syncopal event and fell down while walking in her home. Syncope was preceded by about 15 minutes of flushing, nausea and palpitations. She reported similar episodes once weekly in the preceding months, which generally lasted an hour. Initial workup included normal vital signs at presentation, normal ECG and echocardiogram, normal TFT, CBC, complete metabolic panel. Subsequent head/neck CT revealed bilateral masses in the carotid bifurcations consistent with carotid body tumors. Further history revealed a family history of bilateral carotid body tumors in her father which had never been evaluated. Plasma and urine metanephrines were normal. She underwent carotid body tumor excision. The left carotid body tumor was successfully excised and pathology revealed a paraganglioma with positive synaptophysin and chromogranin stains. Genetic testing revealed an SDHD (succinate dehydrogenase complex subunit D) gene mutation. Repeat biochemical assessment 4 months later was again negative and patient remained asymptomatic postoperatively.Conclusion:Paragangliomas can be secretory or non-secretory with about 95% of head and neck paragangliomas being non-secretory, as in this case. Symptoms can arise from catecholamine hypersecretion, which generally presents as hypertension, headaches, diaphoresis, flushing, anxiety or palpitations, and can be episodic or sustained, or mass effect. Syncope as a presenting symptom is rare, however, and has not been quantified but only reported in case reports. The exact etiology of syncope in our patient is not clear. Hereditary PGL/PCC syndromes should be suspected in any individual with multiple, recurrent, early-onset (age less than 45 years) or family history of PGL/PCC, as these syndromes are inherited in an autosomal dominant manner.

Mediastinal paraganglioma successfully resected by robot-assisted thoracoscopic surgery with en bloc chest wall resection: a case report

BackgroundRobot-assisted thoracoscopic surgery (RATS) is useful for surgery in the apical region of the chest cavity, as it narrows towards the head. Here, we describe a nonfunctional, rib-invasive paraganglioma arising in the posterior mediastinum that was successfully removed using RATS combined with chest wall resection.Case presentationA 31-year-old woman presented with a posterior mediastinal mass on chest computed tomography (CT) scan during a medical check-up 2 years prior. Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose revealed a mass associated with standardized uptake maximum value of 2.69. With a preoperative diagnosis of neurogenic tumor by CT-guided percutaneous fine-needle aspiration biopsy, we performed robot-assisted tumor resection combined with chest wall resection. The wristed instruments of the robotic surgical system have increased range of motion and enabled the tumor resection without organ injury in the thoracic cavity. Histopathology examination revealed a non-functional paraganglioma with rib invasion.ConclusionsRATS is a useful technique, enabling safer and easier resection of a mediastinal tumor adjacent to surrounding organs.

A rare mesentric tumor “paraganglioma” – a case report

Paraganglioma are rare type of neuroendocrine tumors that arise from embryonal neural crest. Paraganglioma of adrenal medulla is known as Pheochromocytoma. Extra adrenal localization has incidence of 2-8 per million people per year, which can extend from upper cervical region to pelvis related to autonomic nervous system. Even rarer is occurrence of paragangliomas outside the usual distribution of paraganglionic tissue. Mesenteric paragangliomas are extremely rare. The present case was of a non-functional extra adrenal paraganglioma occurring in a 43-year-old male presented with complain of pain in abdomen and mild discomfort. Abdominal CECT revealed well defined enhancing solid mass with central necrosis in right side of mesentry. Explorative laparotomy and surgical excision were done, on histology typical “zellballen” pattern was found. Paragangliomas are rare neuroendocrine tumor known to store and secrete catecholamines and hence are known as functional paragangliomas and may present with symptoms like headache, sweating, palpitations and hypertension. On other hand, they may remain silent and non-functional and present with vague symptoms like pain abdomen due to episodic release of catecholamines. Surgical excision is treatment of choice. Long term follow up is mandatory as tumor is prone to recur and metastasize.

Metabolically quiescent paraganglioma in a patient with carcinoma cervix: An unusual presentation

Paragangliomas (PGLs) are rare tumours arising from sympathetic and parasympathetic paraganglial neural crest cells. Functional PGLs usually present with manifestations of catecholamine excess such as hypertension, flushing and diaphoresis. Non-functional PGLs are diagnosed incidentally during imaging studies and pose a significant diagnostic challenge. Here, we report the case of 42-year-old female patient with carcinoma cervix who presented with a non-fluorodeoxyglucose-avid PGL. This case report highlights the importance of considering PGL in differential diagnosis and the management of retroperitoneal tumours.

Differentiating Nonfunctional Paraganglioma of the Bladder from Urothelial Carcinoma of the Bladder: Pitfalls and Breakthroughs.

Background Although both nonfunctional paraganglioma of the bladder (NPB) and urothelial carcinoma of the bladder (UCB) are subtypes of bladder tumors, they are entirely different entities with distinct tissue origins and anatomical locations. However, NPB is frequently misdiagnosed as UCB chiefly due to the similarities in their clinical characteristics and cystoscopic features. This study aimed to compare the differences in their clinical characteristics and cystoscopic features. Patients and Methods Between April 2007 and September 2017, 14 patients with NPB (NPB group) were retrieved from 2 centers, and 42 patients with new-onset UCB (UCB group) were randomly retrieved. Demographic, symptomatic, imaging, and cystoscopic data of patients in both groups were collected and compared. Results NPB group comprised 7 males and 7 females, with a mean age of 43.1 ± 13.6 years. Compared with the UCB group, patients in the NPB group were significantly younger (p < 0.001), less likely to be male (p < 0.05), and to present with hematuria (p < 0.01). However, no significant difference in maximum tumor diameter was observed between the 2 groups (p=0.609). Compared with the UCB group, cystoscopically, patients in the NPB group were significantly more likely to present with hypervascularization but less likely to present with hemorrhage, necrosis, calcification, pedunculation, and multilesion (p < 0.05). No patients with NPB were clinically diagnosed correctly before cystoscopy. Of the 5 patients who underwent both cystoscopy and biopsy, 4 were diagnosed with NPB, while 1 remained undiagnosed. Of the remaining 9 patients who underwent cystoscopy only, 5 were diagnosed with nonepithelial tumor, and 4 were misdiagnosed with UCB. Conclusions Age, sex, and hematuria may provide clues to differentiating NPB from UCB. Differences in cystoscopic features between NPB and UCB are of high diagnostic value. Cystoscopic biopsy should be considered in the preoperative diagnosis of NPB.

Non-functional paraganglioma of urinary bladder managed by transurethral resection.

ABSTRACTPurpose As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB. This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT).Materials and Methods The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment.Results The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up period of 36.4 ± 24.8 months.Conclusion Complete TURBT is a safe and efficient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confirmation. Long-term follow-up is recommended for patients with non-functional PUB.

Middle mediastinal paraganglioma with blood supply by branch of left coronary artery: one case report

Paragangliomas are neuroendocrine tumors arising from extra-adrenal chromaffin cells of the autonomic nervous system and mediastinal paragangliomas are thought to deriving from para-aortic and para-vertebral ganglion chain. We present a 40-year-old woman with a middle mediastinal mass that was fed by branch of left coronary artery, and was finally diagnosed as primary mediastinal non-functional paraganglioma. The thoracic paraganglioma is extremely rare and it was unreliable to predict biologic behavior from the perspective of morphology. Excluding metastatic lesion and complete surgical resection are important to prognosis.

Imaging Findings of Primary Non-functioning Hepatic Paraganglioma: A Case Report

Imaging Findings of Primary Non-functioning Hepatic Paraganglioma: A Case Report

Primary unresectable locally invasive biatrial paraganglioma presenting with chest pain

Paragangliomas, neuroendocrine tumors of neural crest origin, commonly occur in the adrenal medulla where they are called pheochromocytoma. Primary cardiac paragangliomas are uncommon whereby they arise in the left atrium and, less frequently, right atrium. We present a 43-year-old female with a cardiac paraganglioma presenting with ischemic and positional chest pains. CT scanning showed an infiltrative 15×10cm unresectable tumor with intense peripheral enhancement and central hypoattenuation located above the right atrium. The clinical impression was that of a high-grade sarcoma. Histopathological examination revealed tumor cell nests in a distinctive ‘Zellballen’ pattern with positive synaptophysin, chromogranin and GATA-3 staining confirming the diagnosis of paraganglioma. Immunohistochemical studies revealed that the tumor lacked the expression of SDHB and therefore indicating a SDHB gene mutation. The tumor was nonfunctioning, and therefore the absence of the classic adrenergic manifestations contributed to the late diagnosis of the condition. In conclusion, whereas preoperative diagnosis is challenging with nonfunctional paragangliomas, it is recommended that paragangliomas be considered in the differential diagnosis of cardiac neoplasms.

Endoscopic Ultrasound-Guided Fine Needle Biopsy for the Diagnosis of Paraganglioma

Paragangliomas are rare neuroendocrine tumors that originate from the extra-adrenal autonomic ganglia. They should be included in the differential diagnosis of retroperitoneal tumors. Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been increasingly used as an effective tool for obtaining diagnostic tissue for histology and molecular studies. We are reporting a patient who was found to have a retroperitoneal mass as an incidental finding and was successfully diagnosed as a non-functional paraganglioma using EUS-FNB without any complications. 50-years-old man who presented to the emergency department after a high-speed motorcycle accident; Computed tomography showed large retroperitoneal mass measuring 9.6 x 12.5 cm. It was a peripherally enhancing, centrally necrotic mass that abuts the Inferior vena cava and aorta. EUS-FNB showed an epitheliod lesion composed of medium sized cells with moderate eosinophilic to clear cytoplasm. Immunostains showed the tumor cells to be positive for CD56 and synaptophysin but negative for pancytokeratins AE1/3 and CAM5.2, Pax-8, CK7, inhibin, S-100 and CD117. This indicates neuroendocrine differentiation, consistent with paraganglioma. He tolerated the procedure well without any complications. Biochemical studies were consistent with non-functioning extra adrenal paraganglioma. The following month, he underwent successful surgical resection of the mass. Paragangliomas can be found in different sites, with the majority being found in the abdomen. They could be either functioning or non-functioning. The functional ones secrete norepinephrine and normetanephrine and represent 36% to 60% of the lesions. Less than 10% could turn malignant. EUS-FNB allows preoperative diagnosis of such lesions. In patients with clinical signs of pheochromocytoma, it is advisable to do 24-hour urine collection of catecholamines and metanephrines before performing EUS-FNB as it is contraindicated in functioning paragangliomas as needle insertion could trigger an adrenergic crisis. In conclusion, EUS-FNB is a safe technique for evaluation of retroperitoneal masses. Physicians should consider biochemical testing to exclude functioning paraganglioma in patients with retroperitoneal masses who have clinical signs of pheochromocytoma prior to performing EUS-FNB to avoid intra-procedural complications.Figure: Abdominal CT (upper left) shows large retroperitoneal peripherally enhancing centrally necrotic mass that measures 9.6 x 12.5 X 10.7 cm. EUS (upper right) shows the mass with the needle going through for fine needle aspiration. FNA cytology slide (bottom left) stained with H&E stain shows small epithelioid cells with moderate pleomorphism, and fine salt and pepper chromatin similar to that seen in neuroendocrine tumors. The paraganglioma mass (bottom right) is shown after surgical resection.

Primary hepatic nonfunctional paraganglioma: a report of one case

Primary hepatic nonfunctional paraganglioma: a report of one case

Non-functioning paraganglioma occurring in the urinary bladder: A case report and review of the literature.

Paraganglioma, also termed extra-adrenal pheochromocytoma, may be observed at the base of the skull and neck as well as within the mediastinum and periaortic region. The clinical symptoms of paraganglioma of the urinary bladder include intermittent hypertensive attacks, micturition, headaches and palpitations due to high catecholamine levels; these types of paragangliomas are extremely rare. However, certain bladder paragangliomas do not present with any of these symptoms; thus, surgeons are not pre-warned on how to prepare for their resection. Surgery to remove pheochromocytomas may therefore result in an intraoperative hypertensive crisis and increase the mortality rate. This infrequent type of paraganglioma is only recognized through histological examination following surgery. The current study reports the case of a 61-year-old male with urinary bladder paraganglioma. The patient presented with hypertension, which was controlled to within a normal range using diovan and norvasc treatment; in addition, the patient's blood pressure was not altered with urination or postural changes. The patient was not administered an α-blocking agent or a blood volume expander prior to the surgery, and during the partial cystectomy no hypertensive crisis occurred.