Retroperitoneal extra-adrenal paraganglioma: a rare but important diagnosis

The inferior vena cava: anatomical variants and acquired pathologies

The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.

Primary malignant hepatic paraganglioma mimicking liver tumor: A case report

An extra-adrenal pheochromocytoma is also known as a paraganglioma. The present study reported the case of a 47-year-old female patient with an extremely rare primary nonfunctioning hepatic paraganglioma without any clinical signs and symptoms. A computed tomography scan of the entire abdomen region revealed a hyper-enhanced, well-marginated round mass located in segment 3 of the liver. A preoperative diagnosis of hepatocellular carcinoma was established and a left lateral hepatic lobectomy was performed. During the removal of the mass, the patient experienced extreme fluctuations in blood pressure. Analysis of hepatic and peripheral venous blood test results confirmed the increase of noradrenaline secretion. Postoperatively, the patient's blood pressure and catecholamine level returned to the normal range. However, three years after surgery, a plasma catecholamine examination revealed a high noradrenaline level. Abdominal magnetic resonance imaging scans revealed two metastases, located in the spleen and below the right posterior lobe of the liver, which were identified as malignant paragangliomas. Therefore, the patient was diagnosed with primary malignant hepatic paraganglioma recurrence three years after hepatic resection.

Resection of a malignant paraganglioma located behind the retrohepatic segment of the inferior vena cava

BACKGROUND

Resection of a retrocaval paraganglioma is technically challenging due to limited tumor accessibility and proximity to the vena cava.

CASE PRESENTATION

A large, malignant paraganglioma was found behind the retrohepatic segment of the inferior vena cava of a 60-year-old male. During resection of this rare paraganglioma, the left lateral lobe of the liver, a portion of the caudate lobe of the liver, and the gallbladder were also removed. Unfortunately, the patient died six months after surgery due to hepatic metastasis.

CONCLUSION

This case demonstrates that a partial hepatectomy may be necessary to improve tumor accessibility during resection of a retrocaval paraganglioma, particularly if the tumor is proximal to the vena cava. Furthermore, palliative treatments may help prevent tumor recurrence and metastasis of malignant paragangliomas.