1
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Samba S, Bensghier A, Margoum S, Berhili S, Moukhlissi M, Mezouar L. Exploring Head and Neck Paraganglioma: A Case Report. Cureus 2024; 16:e55720. [PMID: 38586626 PMCID: PMC10998543 DOI: 10.7759/cureus.55720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Paragangliomas (PGLs) are tumors that are rarely malignant; the majority of them are benign. Similar to pheochromocytoma, they develop from the autonomic nerve system. This system originates from neural crest cells and can undergo neoplastic transformation. PGLs can arise either inside or outside the adrenal glands. Head and neck PGLs are very scarce. The primary locations where this tumor commonly originates within this region are the carotid body, jugular bulb, and vagal body. Hence, in our case report, we attempt to highlight the uncommon presentation of this disease in a 46-year-old female, who initially presented with hypertension and persistent dysphonia. The patient underwent successful external radiotherapy. This case report aims to raise awareness of the characteristics of these rare malignancies.
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Affiliation(s)
- Soumiya Samba
- Department of Radiation Oncology, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Ahmed Bensghier
- Department of Radiation Oncology, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Souad Margoum
- Department of Radiation Oncology, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Soufiane Berhili
- Department of Radiation Oncology, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Mohamed Moukhlissi
- Department of Radiation Oncology, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Loubna Mezouar
- Department of Radiation Oncology, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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2
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Zouraq SA, Haloua M, Alami B, Lamrani MYA, Maaroufi M, Boubbou M. Malignant pelvic paraganglioma: A case report. Radiol Case Rep 2022; 17:2342-2345. [PMID: 35570870 PMCID: PMC9096467 DOI: 10.1016/j.radcr.2022.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Pheochromocytomas arising from outside the adrenal glands are called paragangliomas and constitute a rare disease and can occur in the pelvic retroperitoneum. Symptoms of excess catecholamine production, as well as elevated urine vanillylmandelic acid levels and serum and urine norepinephrine levels, are highly diagnostic for paraganglioma. Imaging can be helpful for the diagnostic of these pelvic tumors, differentiating them from other pelvic masses. We hereby present a case of pelvic malignant paraganglioma.
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3
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Gombert A, Diana A, Hecht S, Nicoli S, Fracassi F, Mortier J, Reyes-Gomez E, Pey P. Imaging features of retroperitoneal extra-adrenal paragangliomas in 10 dogs. Vet Radiol Ultrasound 2022; 63:393-402. [PMID: 35050528 PMCID: PMC9546460 DOI: 10.1111/vru.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/31/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022] Open
Abstract
Retroperitoneal paragangliomas are rare tumors of the neuroendocrine system. Only a few canine case reports are available with rare descriptions of their imaging features. The objectives of this multi‐center, retrospective case series study were to describe the diagnostic imaging features of confirmed retroperitoneal paragangliomas and specify their location. Medical records and imaging studies of 10 affected dogs with cytological or histopathologic results concordant with retroperitoneal paragangliomas were evaluated. Dogs had a median age of 9 years. Four of them had clinical signs and laboratory reports compatible with excessive production of catecholamines. Six ultrasound, four CT, four radiographic, and one MRI studies were included. The paragangliomas did not have a specific location along the aorta. They were of various sizes (median 33 mm, range: 9–85 mm of length). Masses had heterogeneous parenchyma in six of 10 dogs, regardless of the imaging modality. Strong contrast enhancement was found in all CT studies. Encircling of at least one vessel was detected in six of 10 masses, clear invasion of a vessel was identified in one of 10 masses. In five of 10 cases, the masses were initially misconstrued as lymph nodes by the on‐site radiologist. Retroperitoneal paragangliomas appear along the abdominal aorta, often presenting heterogeneous parenchyma, possibly affecting the local vasculature, and displaying strong contrast enhancement on CT. Clinical signs can be secondary to mass effects or excessive catecholamine production. Underdiagnosis and misdiagnosis of this tumor are suspected as they can be silent, of small size, or confused with other structures.
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Affiliation(s)
- Alexis Gombert
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Alessia Diana
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Ozzano Emilia, Italy
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | | | - Federico Fracassi
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Ozzano Emilia, Italy
| | - Jeremy Mortier
- Department of Small Animal Clinical Sciences, University of Liverpool, Neston, UK
| | - Edouard Reyes-Gomez
- Histology and Anatomical Pathology Unit, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Ecole Nationale Vétérinaire d'Alfort, U955-IMRB, Inserm, UPEC, Maisons-Alfort, France
| | - Pascaline Pey
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Ozzano Emilia, Italy
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4
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Otlyga D, Tsvetkova E, Junemann O, Saveliev S. Immunohistochemical Characteristics of the Human Carotid Body in the Antenatal and Postnatal Periods of Development. Int J Mol Sci 2021; 22:8222. [PMID: 34360987 PMCID: PMC8348551 DOI: 10.3390/ijms22158222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 02/01/2023] Open
Abstract
The evolutionary and ontogenetic development of the carotid body is still understudied. Research aimed at studying the comparative morphology of the organ at different periods in the individual development of various animal species should play a crucial role in understanding the physiology of the carotid body. However, despite more than two centuries of study, the human carotid body remains poorly understood. There are many knowledge gaps in particular related to the antenatal development of this structure. The aim of our work is to study the morphological and immunohistochemical characteristics of the human carotid body in the antenatal and postnatal periods of development. We investigated the human carotid bodies from 1 embryo, 20 fetuses and 13 adults of different ages using samples obtained at autopsy. Immunohistochemistry revealed expression of βIII-tubulin and tyrosine hydroxylase in the type I cells and nerve fibers at all periods of ontogenesis; synaptophysin and PGP9.5 in the type I cells in some of the antenatal cases and all of the postnatal cases; 200 kDa neurofilaments in nerve fibers in some of the antenatal cases and all of the postnatal cases; and GFAP and S100 in the type II cells and Schwann cells in some of the antenatal cases and all of the postnatal cases. A high level of tyrosine hydroxylase in the type I cells was a distinctive feature of the antenatal carotid bodies. On the contrary, in the type I cells of adults, the expression of tyrosine hydroxylase was significantly lower. Our data suggest that the human carotid body may perform an endocrine function in the antenatal period, while in the postnatal period of development, it loses this function and becomes a chemosensory organ.
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Affiliation(s)
- Dmitry Otlyga
- Research Institute of Human Morphology, 117418 Moscow, Russia; (E.T.); (O.J.); (S.S.)
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5
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Gonzalez K, Singh MJ. Open abdominal aortic aneurysm repair with incidental finding of an extra-adrenal pheochromocytoma of the organ of Zuckerkandl. Vascular 2020; 29:202-206. [PMID: 32838691 DOI: 10.1177/1708538120950868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. The most common location of these tumors is within the adrenal medulla. Extra-adrenal pheochromocytomas (EAPs) may occur in any portion of the paraganglion system. The most common location of EAPs is at the organ of Zuckerkandl, which is a collection of chromaffin cells near the origin of the inferior mesenteric artery. METHODS We present a case of an EAP of the organ of Zuckerkandl incidentally discovered and resected during urgent open repair of a symptomatic 6.7-cm juxtarenal abdominal aortic aneurysm (AAA). RESULTS The patient underwent successful open surgical repair of a juxtarenal AAA and resection of the pheochromocytoma. CONCLUSIONS Concomitant pheochromocytomas and abdominal aortic aneurysms are rare, with a small number described in the literature. We describe the case of a simultaneous EAP of the organ of Zuckerkandl and AAA repair. This case demonstrates that these lesions can be safely resected in the same setting as AAA repair.
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Affiliation(s)
- Kathy Gonzalez
- 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael J Singh
- 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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6
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A Case Report of Paraganglioma: A Diagnosis Not to Be Missed. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.99817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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7
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Hegazi TM, Al-Sharydah AM, Lee KS, Mortele K. Retroperitoneal cystic masses: magnetic resonance imaging features. Abdom Radiol (NY) 2020; 45:499-511. [PMID: 31583446 DOI: 10.1007/s00261-019-02246-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of this review is to discuss the clinical and histopathologic features, MRI characteristics, and management options of retroperitoneal cystic masses. Radiologists should be familiar with the MR imaging characteristics of retroperitoneal cystic masses to allow for a refined differential diagnosis, assist with lesion management, and prevent unnecessary invasive procedures.
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Affiliation(s)
- Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | | | - Karen S Lee
- Division of Abdominal Imaging/Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Koenraad Mortele
- Division of Abdominal Imaging/Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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8
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Ierardi AM, Biondetti P, Ferrante G, Carugo S, Carrafiello G. Immediate Clinical Success After Percutaneous Ablation of Extra-adrenal Paraganglioma. Cardiovasc Intervent Radiol 2018; 41:1803-1806. [PMID: 29922859 DOI: 10.1007/s00270-018-2015-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022]
Abstract
Paragangliomas (PGLs) are catecholamine-secreting neoplasms of chromaffin cells and represent a rare but curable cause of secondary hypertension. Surgery is the treatment of choice for symptomatic PGLs. A small (7 mm) extra-adrenal PGL was diagnosed in the right retroperitoneal space in a 19-year-old patient affected by symptomatic hypertension unresponsive to medical treatment. Indication to percutaneous radiofrequency ablation (RFA) was given by a multidisciplinary team on the basis of the size of the nodule, the surgical risks, the young age of the patient, and his wish to reduce as much as possible the post-interventional rehabilitation. To our knowledge, the use of percutaneous RFA in the treatment of retroperitoneal extra-adrenal primary paragangliomas has never been described. We describe its feasibility and the patient's clinical outcome.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy
| | - Giulia Ferrante
- Heart and Lung Department, ASST Santi Paolo and Carlo, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy
| | - Stefano Carugo
- Heart and Lung Department, ASST Santi Paolo and Carlo, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy.
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9
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Chan WH, Anderson CR, Gonsalvez DG. From proliferation to target innervation: signaling molecules that direct sympathetic nervous system development. Cell Tissue Res 2017; 372:171-193. [PMID: 28971249 DOI: 10.1007/s00441-017-2693-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/30/2017] [Indexed: 02/07/2023]
Abstract
The sympathetic division of the autonomic nervous system includes a variety of cells including neurons, endocrine cells and glial cells. A recent study (Furlan et al. 2017) has revised thinking about the developmental origin of these cells. It now appears that sympathetic neurons and chromaffin cells of the adrenal medulla do not have an immediate common ancestor in the form a "sympathoadrenal cell", as has been long believed. Instead, chromaffin cells arise from Schwann cell precursors. This review integrates the new findings with the expanding body of knowledge on the signalling pathways and transcription factors that regulate the origin of cells of the sympathetic division of the autonomic nervous system.
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Affiliation(s)
- W H Chan
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Parkville, 3010, Australia
| | - C R Anderson
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Parkville, 3010, Australia
| | - David G Gonsalvez
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Parkville, 3010, Australia.
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10
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Abdullah AE, Guerin C, Imperiale A, Barlier A, Battini S, Pertuit M, Roche P, Essamet W, Vaisse B, Pacak K, Sebag F, Taïeb D. Paraganglioma of the organ of Zuckerkandl associated with a somatic HIF2α mutation: A case report. Oncol Lett 2017; 13:1083-1086. [PMID: 28454217 PMCID: PMC5403169 DOI: 10.3892/ol.2017.5599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Abstract
Paragangliomas of the organ of Zuckerkandl (OZ-PGL) are rare tumors that, in >70% of cases, occur in association with succinate dehydrogenase complex iron sulfur subunit B (SDHB) or SDHD gene mutations. The aim of the current study was to determine whether a somatic genetic defect in the hypoxia-inducible factor 2α (HIF2α) gene was present in a case of sporadic OZ-PGL. A 32-year-old African female presented with uncontrolled hypertension during the first trimester of pregnancy. A diagnostic hysteroscopy was performed 3 months after delivery, precipitating a hypertensive crisis. Thereafter, the patient was diagnosed with noradrenaline-secreting OZ-PGL. A complete blood count identified mild normocytic anemia of an inflammatory origin. Surgical removal of the tumor resulted in normalization of plasma and urinary normetanephrine levels. Genetic testing for germline mutations (including large deletions) in the von Hippel-Lindau tumor suppressor, SDHB, SDHC and SDHD genes was normal. However, a heterozygous missense mutation (c.1589Cys>Tyr) was detected in exon 12 of HIF2α, which results in a substitution of alanine 530 with valine (Ala530Val) in the HIF2α protein. A germline mutation was excluded based on the negative results of blood DNA testing. A three-dimensional homology model of Ala530Val was constructed, which showed impaired HIF2α/VHL interaction and decreased HIF2α ubiquitination. 1H-high-resolution magic-angle-spinning nuclear magnetic resonance spectroscopy detected low succinate levels and high α and β glucose levels. To the best of our knowledge, the present case represents the first of its kind to associate a somatic HIF2α gain-of-function mutation with OZ-PGL. It is therefore recommended that patients without germline SDHx mutations should be tested for HIF2α mutations.
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Affiliation(s)
- Ahmad Esmaeel Abdullah
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Carole Guerin
- Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Alessio Imperiale
- Department of Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 67200 Strasbourg, France.,ICube Joint Research Unit 7357, University of Strasbourg/French National Center for Scientific Research and Federation of Translational Medicine of Strasbourg, Faculty of Medicine, 67085 Strasbourg, France
| | - Anne Barlier
- Laboratory of Biochemistry and Molecular Biology, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Stéphanie Battini
- Integrative Structural and Chemical Biology and Interaction Dynamics and Drug Design Platform, Cancer Research Centre of Marseille, Institut Paoli Calmettes, 13273 Marseille, France.,Department of Neuropathology, La Timone University Hospital, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Morgane Pertuit
- Laboratory of Biochemistry and Molecular Biology, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Philippe Roche
- Integrative Structural and Chemical Biology and Interaction Dynamics and Drug Design Platform, Cancer Research Centre of Marseille, Institut Paoli Calmettes, 13273 Marseille, France
| | - Wassim Essamet
- Department of Neuropathology, La Timone University Hospital, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Bernard Vaisse
- Department of Hypertension, La Timone University Hospital, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Fréderic Sebag
- Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, 13385 Marseille Cedex 5, France.,Cancer Research Centre of Marseille Affiliated to Inserm (UMR1068), Institut Paoli-Calmettes, 13273 Marseille, France
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11
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Salgaonkar H, Behera RR, Sharma PC, Chadha M, Katara AN, Bhandarkar DS. Laparoscopic resection of a large paraganglioma arising in the organ of Zuckerkandl: Report of a case and review of the literature. J Minim Access Surg 2016; 12:378-81. [PMID: 27251804 PMCID: PMC5022524 DOI: 10.4103/0972-9941.169990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Paragangliomas are catecholamine-secreting neuroendocrine tumours arising from chromaffin tissue at extra-adrenal sites. The commonest site for a paraganglioma is the organ of Zuckerkandl. Traditional treatment of paraganglioma of organ of Zuckerkandl (POZ) involves open surgical resection, and only a few cases of laparoscopic approach to this pathology have been reported. We report the successful laparoscopic resection of a large POZ in a 22-year-old woman and review the previous cases reporting a laparoscopic approach to this rare tumour.
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Affiliation(s)
| | - Ramya Ranjan Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Manoj Chadha
- Department of Endocrinology, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Avinash N Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Deepraj S Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
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12
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Evangelista Sánchez EM, Doiz Artázcoz E, Rodríguez Piñero M, Craven-Bartle Coll A, Conejero Gómez R. Paraganglioma of Zuckerkandl's organ. Cir Esp 2016; 94:483-4. [PMID: 27166450 DOI: 10.1016/j.ciresp.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Esther Doiz Artázcoz
- UGC Angiología y Cirugía Vascular, Hospital Universitario Puerta del Mar, Cádiz, España
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14
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Halfya A, Elmortaji K, Elmrini M, Houry Y, Osman S, Tounsi K, Rabii R, Aboutaib R, Dakir M, Debbagh A, Meziane F. [Non secreting paraganglioma of Zuckerkandl organ]. Pan Afr Med J 2015; 20:130. [PMID: 26097634 PMCID: PMC4462554 DOI: 10.11604/pamj.2015.20.130.5968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/31/2015] [Indexed: 11/11/2022] Open
Abstract
Le Phéochromocytome extra-surrénalien ou paragangliome est une tumeur rare. Il dérive de la crête neurale du système neuroendocrinien et il est souvent sécrétant. La plupart de ces tumeurs sont situées dans les ganglions sympathiques abdominaux, y compris l'organe de Zuckerkandl adjacent à la bifurcation de l'aorte abdominale. Les Formes non fonctionnelles sont rares: moins de 50 cas sont rapportés dans la littérature. Nous rapportons le cas d'un paragangliome non sécrétant de l'organe de Zuckerkandl opéré au sein de notre service d'urologie ainsi qu'une revue de la littérature afin de discuter les différents aspects diagnostiques et thérapeutiques de cette entité tumorale rare.
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Affiliation(s)
- Ayoub Halfya
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | | | | | - Younes Houry
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | - Said Osman
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | - Karime Tounsi
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | - Redouane Rabii
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | | | - Mohamed Dakir
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | - Adil Debbagh
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
| | - Fethi Meziane
- Service d'Urologie du CHU Ibn Rochd de Casablanca, Maroc
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15
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Schober A, Parlato R, Huber K, Kinscherf R, Hartleben B, Huber TB, Schütz G, Unsicker K. Cell loss and autophagy in the extra-adrenal chromaffin organ of Zuckerkandl are regulated by glucocorticoid signalling. J Neuroendocrinol 2013; 25:34-47. [PMID: 23078542 PMCID: PMC3564403 DOI: 10.1111/j.1365-2826.2012.02367.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/27/2012] [Indexed: 12/20/2022]
Abstract
Neuroendocrine chromaffin cells exist in both intra- and extra-adrenal locations; the organ of Zuckerkandl (OZ) constitutes the largest accumulation of extra-adrenal chromaffin tissue in mammals. The OZ disappears postnatally by modes that are still enigmatic but can be maintained by treatment with glucocorticoids (GC). Whether the response to GC reflects a pharmacological or a physiological role of GC has not been clarified. Using mice with a conditional deletion of the GC-receptor (GR) gene restricted to cells expressing the dopamine β-hydroxylase (DBH) gene [GR(fl/fl) ; DBHCre abbreviated (GR(DBHCre) )], we now present the first evidence for a physiological role of GC signalling in the postnatal maintenance of the OZ: postnatal losses of OZ chromaffin cells in GR(DBHCre) mice are doubled compared to wild-type littermates. We find that postnatal cell loss in the OZ starts at birth and is accompanied by autophagy. Electron microscopy reveals autophagic vacuoles and autophagolysosomes in chromaffin cells. Autophagy in OZ extra-adrenal chromaffin cells is confirmed by showing accumulation of p62 protein, which occurs, when autophagy is blocked by deleting the Atg5 gene (Atg5(DBHCre) mice). Cathepsin-D, a lysosomal marker, is expressed in cells that surround chromaffin cells and are positive for the macrophage marker BM8. Macrophages are relatively more abundant in mice lacking the GR, indicating more robust elimination of degenerating chromaffin cells in GR(DBHCre) mice than in wild-type littermates. In summary, our results indicate that extra-adrenal chromaffin cells in the OZ show signs of autophagy, which accompany their postnatal numerical decline, a process that is controlled by GR signalling.
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Affiliation(s)
- Andreas Schober
- Department of Molecular Embryology, Institute of Anatomy and Cell Biology II, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
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16
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Shanbhogue AK, Fasih N, Macdonald DB, Sheikh AM, Menias CO, Prasad SR. Uncommon primary pelvic retroperitoneal masses in adults: a pattern-based imaging approach. Radiographics 2012; 32:795-817. [PMID: 22582360 DOI: 10.1148/rg.323115020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a broad spectrum of primary pelvic retroperitoneal masses in adults that demonstrate characteristic epidemiologic and histopathologic features and natural histories. These masses may be classified into five distinct subgroups using a pattern-based approach that takes anatomic distribution and certain imaging characteristics into account, allowing greater accuracy in their detection and characterization and helping to optimize patient management. The five groups are cystic (serous and mucinous epithelial neoplasms, pelvic lymphangioma, tailgut cyst, ancient schwannoma), vascular or hypervascular (solitary fibrous tumor, paraganglioma, pelvic arteriovenous malformation, Klippel-Trénaunay-Weber syndrome, extraintestinal GIST [gastrointestinal stromal tumor]), fat-containing (lipoma, liposarcoma, myelolipoma, presacral teratoma), calcified (calcified lymphocele, calcified rejected transplant kidney, rare sarcomas), and myxoid (schwannoma, plexiform neurofibroma, myxoma).Cross-sectional imaging modalities help differentiate the more common gynecologic neoplasms from more unusual masses. In particular, the tissue-specific multiplanar capability of high-resolution magnetic resonance imaging permits better tumor localization and internal characterization, thereby serving as a road map for surgery.
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Affiliation(s)
- Alampady K Shanbhogue
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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Karaman K, Teke Z, Dalgic T, Ulas M, Seven MC, Zulfikaroglu E, Sakaogullari Z, Bostanci EB. Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: report of a case. Surg Today 2010; 41:153-8. [PMID: 21191710 DOI: 10.1007/s00595-009-4207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 09/01/2009] [Indexed: 12/15/2022]
Abstract
Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.
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Affiliation(s)
- Kerem Karaman
- Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey
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18
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Lodish MB, Adams KT, Huynh TT, Prodanov T, Ling A, Chen C, Shusterman S, Jimenez C, Merino M, Hughes M, Cradic KW, Milosevic D, Singh RJ, Stratakis CA, Pacak K. Succinate dehydrogenase gene mutations are strongly associated with paraganglioma of the organ of Zuckerkandl. Endocr Relat Cancer 2010; 17:581-8. [PMID: 20418362 PMCID: PMC3417306 DOI: 10.1677/erc-10-0004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Organ of Zuckerkandl paragangliomas (PGLs) are rare neuroendocrine tumors that are derived from chromaffin cells located around the origin of the inferior mesenteric artery extending to the level of the aortic bifurcation. Mutations in the genes encoding succinate dehydrogenase subunits (SDH) B, C, and D (SDHx) have been associated with PGLs, but their contribution to PGLs of the organ of Zuckerkandl PGLs is not known. We aimed to describe the clinical presentation of patients with PGLs of the organ of Zuckerkandl and investigate the prevalence of SDHx mutations and other genetic defects among them. The clinical characteristics of 14 patients with PGL of the organ of Zuckerkandl were analyzed retrospectively; their DNA was tested for SDHx mutations and deletions. Eleven out of 14 (79%) patients with PGLs of the organ of Zuckerkandl were found to have mutations in the SDHB (9) or SDHD (2) genes; one patient was found to have the Carney-Stratakis syndrome (CSS), and his PGL was discovered during surgery for gastrointestinal stromal tumor. Our results show that SDHx mutations are prevalent in pediatric and adult PGLs of the organ of Zuckerkandl. Patients with PGLs of the organ of Zuckerkandl should be screened for SDHx mutations and the CSS; in addition, asymptomatic carriers of an SDHx mutation among the relatives of affected patients may benefit from tumor screening for early PGL detection.
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Affiliation(s)
- Maya B Lodish
- Section on Endocrinology & Genetics & Pediatric Endocrinology Program, Program on Developmental Endocrinology & Genetics (PDEGEN), National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Building 10-CRC 10 Center Drive, room 1-3330 Bethesda, MD 20892
| | - Karen T Adams
- Reproductive Biology and Adult Endocrinology Program, NICHD, NIH, Bethesda, MD, United States, 20892
| | - Thanh T Huynh
- Reproductive Biology and Adult Endocrinology Program, NICHD, NIH, Bethesda, MD, United States, 20892
| | - Tamara Prodanov
- Reproductive Biology and Adult Endocrinology Program, NICHD, NIH, Bethesda, MD, United States, 20892
| | - Alex Ling
- Department of Diagnostic Radiology, Warren Grant Magnuson Clinical Center, NIH, Bethesda, MD 20892
| | - Clara Chen
- Department of Diagnostic Radiology, Warren Grant Magnuson Clinical Center, NIH, Bethesda, MD 20892
| | - Suzanne Shusterman
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, United States, 02115
| | - Camilo Jimenez
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States, 77030
| | - Maria Merino
- Department of Pathology, National Cancer Institute, NIH, Bethesda MD 20892
| | - Marybeth Hughes
- Department of Surgery, National Cancer Institute, NIH, Bethesda, MD 20892
| | - Kendall W Cradic
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN 55905
| | - Dragana Milosevic
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN 55905
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN 55905
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics & Pediatric Endocrinology Program, Program on Developmental Endocrinology & Genetics (PDEGEN), National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Building 10-CRC 10 Center Drive, room 1-3330 Bethesda, MD 20892
| | - Karel Pacak
- Reproductive Biology and Adult Endocrinology Program, NICHD, NIH, Bethesda, MD, United States, 20892
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Abstract
The TMEM16 protein family has recently been identified through several different experimental strategies including bioinformatic and microarray-based approaches. In mice and humans, there exist 10 paralogs with each containing eight putative transmembrane domains and a conserved C-terminal domain of unknown function. Mutation of at least one member of this family is associated with a human disorder, and several members of this gene family are overexpressed in different types of cancer. Despite their apparent relevance to normal development and disease, little is known about the expression of TMEM16 paralogs during embryonic development. Here, we provide a phylogenetic analysis of mouse and human TMEM16 paralogs and report the expression of Tmem16a, Tmem16b, Tmem16c, Tmem16f, Tmem16h, Tmem16j, and Tmem16k during murine embryogenesis with an emphasis on the respiratory, digestive, skeletal, and integumentary systems. These data should encourage investigations into the functions of TMEM16 paralogs in vertebrate development.
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Affiliation(s)
- Jason R Rock
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, USA
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Sunagawa H, Inamine S, Zaha H, Takeshima M, Miyata M. Advanced gastric carcinoma combined with extra-adrenal pheochromocytoma resected after three courses of S-1 and cisplatin as neoadjuvant chemotherapy: report of a case. Surg Today 2008; 38:445-8. [PMID: 18560969 DOI: 10.1007/s00595-007-3656-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 09/04/2007] [Indexed: 12/29/2022]
Abstract
We herein describe the case of a patient with advanced gastric carcinoma combined with extra-adrenal pheochromocytoma who received a radical operation after undergoing neoadjuvant chemotherapy. A 48-year-old woman was referred to our hospital for gastric carcinoma. Computed tomography revealed an enlargement of the regional lymph nodes and a para-aortic lymph node. A diagnosis of advanced gastric carcinoma was made (cT3, cN3, cM0, cStage IV according to the Japanese Classification of Gastric Carcinoma, 2nd English edition). A reduction in size was observed in both the gastric tumor and the lymph nodes around the stomach after neoadjuvant chemotherapy. However, the paraaortic lymph node showed no remarkable change. We thus suspected this para-aortic tumor not to be a lymph node, but instead to be an extra-adrenal pheochromocytoma, because of the different response from the other regional lymph nodes. An endocrinological examination confirmed the diagnosis of extra-adrenal pheochromocytoma. A gastrectomy and a resection of the pheochromocytoma were thus performed.
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Phitayakorn R, Mchenry CR. Laparoscopic and Selective Open Resection for Adrenal and Extraadrenal Neuroendocrine Tumors. Am Surg 2008. [DOI: 10.1177/000313480807400108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laparoscopic resection is preferred for most adrenal tumors. From 1996 to 2007, 54 consecutive patients who underwent resection of an adrenal tumor or extraadrenal pheochromocytoma were reviewed to determine the outcome of laparoscopic resection and the rate of conversion and indications for open resection. Adrenalectomy was performed in 51 patients and resection of a pheochromocytoma of the organs of Zuckerkandl in three patients. Laparoscopic adrenalectomy was initiated in 42 patients, three (7.3%) of whom underwent conversion to an open approach because of bleeding from an accessory vein (one), tumor invasion (one), or adhesions (one) (median American Society of Anesthesiologists score = 2, estimated blood loss = 186 ± 235 mL, size = 5 ± 3 cm). Open resection was performed in 12 patients, six at the time of another procedure, three for pheochromocytoma of the organs of Zuckerkandl, two for bilateral adrenalectomy, and one for tumor invasion (median American Society of Anesthesiologists score = 3, estimated blood loss = 1525 ± 978 mL, size = 8 ± 4 cm). With proper patient selection, laparoscopic adrenalectomy can be successfully performed with a low conversion rate. When unrecognized, an accessory right adrenal vein may be a source of significant bleeding requiring conversion to an open approach. Open resection is indicated for tumor invasion, for extraadrenal pheochromocytoma, when laparoscopic resection cannot be performed safely, and for concomitant open procedures.
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Affiliation(s)
- Roy Phitayakorn
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christopher R. Mchenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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