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Paraganglioma of the Middle Mediastinum: Challenging Diagnosis and Curative Treatment
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A4127 - Paraganglioma of the Middle Mediastinum: Challenging Diagnosis and Curative Treatment
Author Block: M. Naddour1, O. Ashraf2, M. Beg2, A. Singh2; 1Allegheny health network, Pittsburgh, PA, United States, 2Allegheny General Hospital,, Pittsburgh, PA, United States.
Introduction: Mediastinal Paragangliomas are usually nonfunctional rare neuroendocrine tumors arising from chromaffin cells usually in the posterior mediastinum. We describe a case of a 56-year-old asymptomatic female with middle mediastinal mass found on a routine Chest CT, and on pathology it was found to be Paraganglioma Case: 56-year-old Caucasian female with a past medical history of 40 pack-year tobacco abuse, hyperlipidemia, and hypothyroidism had a lung cancer CT chest which showed 3.1cm homogeneous irregular lower peritracheal/precarinal soft tissue mass in the mediastinum, between the aorta and superior vena cava. She underwent contrast-enhanced chest MRI which confirmed a necrotic 4.8cm middle-mediastinal mass. Her Endoscopic bronchial ultrasound with FNA was inconclusive and the mass was inaccessible via mediastinoscope. She underwent bilateral VATS but due to excessive bleeding, excision wasn’t possible. Biopsy of the mass demonstrated paraganglioma. She had elevated levels of plasma and urine normetanephrines. Her MIBG scan showed increased uptake in left-lower paratracheal mass without evidence of functioning metastasis. She was treated with phenoxybenzamine pre-operatively and the mass was excised using cardiopulmonary bypass with mobilization of the aortic arch and pulmonary artery. There were no complications and pathology revealed paraganglioma, with free margins and lymph nodes negative for malignancy. Discussion: Mediastinal paragangliomas are rare vascularized tumors originating from enterochromaffin cells which is located in the posterior mediastinum. Functional paragangliomas are extremely rare with hardly 20 cases reported in literature. The uniqueness of our case comes from the location of the paraganglioma in the middle mediastinum which alerts clinicians to keep it in the differential diagnosis of middle mediastinal mass
Author Block: M. Naddour1, O. Ashraf2, M. Beg2, A. Singh2; 1Allegheny health network, Pittsburgh, PA, United States, 2Allegheny General Hospital,, Pittsburgh, PA, United States.
Introduction: Mediastinal Paragangliomas are usually nonfunctional rare neuroendocrine tumors arising from chromaffin cells usually in the posterior mediastinum. We describe a case of a 56-year-old asymptomatic female with middle mediastinal mass found on a routine Chest CT, and on pathology it was found to be Paraganglioma Case: 56-year-old Caucasian female with a past medical history of 40 pack-year tobacco abuse, hyperlipidemia, and hypothyroidism had a lung cancer CT chest which showed 3.1cm homogeneous irregular lower peritracheal/precarinal soft tissue mass in the mediastinum, between the aorta and superior vena cava. She underwent contrast-enhanced chest MRI which confirmed a necrotic 4.8cm middle-mediastinal mass. Her Endoscopic bronchial ultrasound with FNA was inconclusive and the mass was inaccessible via mediastinoscope. She underwent bilateral VATS but due to excessive bleeding, excision wasn’t possible. Biopsy of the mass demonstrated paraganglioma. She had elevated levels of plasma and urine normetanephrines. Her MIBG scan showed increased uptake in left-lower paratracheal mass without evidence of functioning metastasis. She was treated with phenoxybenzamine pre-operatively and the mass was excised using cardiopulmonary bypass with mobilization of the aortic arch and pulmonary artery. There were no complications and pathology revealed paraganglioma, with free margins and lymph nodes negative for malignancy. Discussion: Mediastinal paragangliomas are rare vascularized tumors originating from enterochromaffin cells which is located in the posterior mediastinum. Functional paragangliomas are extremely rare with hardly 20 cases reported in literature. The uniqueness of our case comes from the location of the paraganglioma in the middle mediastinum which alerts clinicians to keep it in the differential diagnosis of middle mediastinal mass
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