>Year 2004, Issue 4
Mondragón SA, Mondragón SR, Alvear M, Bernal MR, Mondragón BR
Inter-aorto-cava retroperitoneal paraganglioma
Cir Gen 2004; 26 (4)
PDF: 4. Kb.
Introduction: Paragangliomas are tumors originated from the chromaffin cells of the neural crest. They can be observed from the base of the skull to the bladder or along the sympathetic ganglionar chain. Retroperitoneal paragangliomas can represent a true surgical challenge due to their tight relation to large size vessels.
Presentation of the case: Woman, of 40 years of age, who, three years before admittance, had presented paroxysmal crises of severe arterial hypertension. The abdominal TC scan revealed the presence of an inter-aorto-cava retroperitoneal mass of 4 cm in diameter compatible with a paraganglioma. The patient was subjected to surgery after having been prepared with calcium channel blockers during two weeks. Surgery confirmed the presence of the inter-aorto-cava paranganglioma of 5 cm in diameter that displaced the cava vein to the front; the tumor was successfully resected. The patient required intensive care and was discharged on the 7th day after surgery without complications. At 24 months, her blood pressure is normal and without recurrence.
Conclusion: Retroperitoneal paragangliomas are not frequent tumors, their surgical treatment is difficult. A multidisciplinary specialized team and close monitoring during the perioperative period are required.
Lamovec J, Frkovic-Grazio S, Bracko M. Nonsporadic cases and unusual morphological features in pheochromocytoma and paraganglioma. Arch Pathol Lab Med 1998; 122: 63-8.
Manger WM, Gifford RW Jr. Pheochromocytoma: current diagnosis and management. Cleve Clin J Med 1993; 60: 365-78.
Jaffer S, Harpaz N. Mesenteric paraganglioma: a case report and review of the literature. Arch Pathol Lab Med 2002; 126: 362-4.
Maier W, Marangos N, Laszig R. Paraganglioma as a systemic syndrome: pitfalls and strategies. J Laryngol Otol 1999; 113: 978-82.
Sclafani LM, Woodruff JM, Brennan MF. Extraadrenal retroperitoneal paragangliomas: natural history and response to treatment. Surgery 1990; 108: 1124-29; discussion 1129-30.
Proye CA, Vix M, Jansson S, Tisell LE, Dralle H, Hiller W. The pheochromocytoma: a benign, intra-adrenal, hypertensive, sporadic unilateral tumor. Does it exist? World J Surg 1994; 18: 467-72.
Lenz T, Gossmann J, Schulte KL, Salewski L, Geiger H. Diagnosis of pheochromocytoma. Clin Lab 2002; 48: 5-18.
Huerga D, Vilches M, Millan A, Mayor A, Souto JL, Ricas S, et al. Medical and surgical treatment of retroperitoneal paraganglioma secretor of catecholamines and erythropoietin. Br J Surg 1997; 84Suppl 2: 106-7.
Proye C. Modern trends in the management of pheochromocytomas and abdominal paragangliomas. Endocrine Surg 1996; 13: 109-23.
Kuzmanovska D, Sahpazova E, Kocova M, Damjanovski G, Popov Z. Pheochromocytoma associated with reversible renal artery stenosis. Nephrol Dial Transplant 2001; 16: 2092-4.
Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med 2001; 134: 315-29.
Manger WM, Gifford RW. Pheochromocytoma. J Clin Hypertens (Greenwich) 2002; 4: 62-72.
Proye CA, Nguyen HH. Current perspectives in the surgery of multiple endocrine neoplasias. Aust N Z J Surg 1999; 69: 106-16.
Proye C, Thevenin D, Cecat P, Petillot P, Carnaille B, Verin P, et al. Exclusive use of calcium-channel blockers in preoperative and intraoperative control of pheochromocytomas: hemodynamics and free catecholamine assays in ten consecutive patients. Surgery 1989; 106: 1149-54.
Goldstein RE, O’Neill JA Jr, Holcomb GW 3rd, Morgan WM 3rd, Neblett WW 3rd, Oates JA, et al. Clinical experience over 48 years with pheochromocytoma. Ann Surg 1999; 229: 755-64; discussion 764-6.
O’Riordain DS, Young WF Jr, Grant CS, Carney JA, van Heerden JA. Clinical spectrum and outcome of functional extraadrenal paraganglioma. World J Surg 1996; 20: 916-21; discussion 922.
Mondragón-Sánchez R, Orellana H, Bernal-Maldonado R, Ruiz-Molina JM. Resection of tumors of the pararenal inferior vena cava with in situ perfusion of the right kidney and graft replacement with bovine pericardium. J Am Coll Surg 1998; 186: 717-9.
Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF. Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms J Am Coll Surg 1996; 183: 1-10.
Janetschek G, Finkenstedt G, Gasser R, Waibel UG, Peschel R, Bartsch G, et al. Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 1998; 160: 330-4.
Taue R, Takigawa H, Sinotou K, Uno S, Mori R, Tatara IG, et al. A case of pelvic malignant paraganglioma. Int J Urol 2001; 8: 715-8.
>Year 2004, Issue 4