Multimodality imaging of aortopulmonary paraganglioma

Neoadjuvant Combined Preoperative Embolization of a Highly Vascularized Paraganglioma Associated With SIADH

BACKGROUND

Device-based embolization is a well-established medical procedure for treating several pathological conditions, including cerebral and peripheral pseudoaneurysms, congenital defects, and active bleeding. Nonetheless, an intriguing and relatively underexplored application of coils and microparticles involves the preoperative reduction of blood supply to ectopic masses.

CASE SUMMARY

A 58-year-old woman was admitted to our institution with nausea and confusion, with a suspected diagnosis of syndrome of inappropriate antidiuretic hormone secretion. A computed tomography scan revealed a large mediastinal mass receiving blood supply from both the bronchial and coronary arteries. The mass was successfully excised surgically, following the embolization of the major feeding vessels using a combination of coils and microspheres.

DISCUSSION

An uncommon presentation of a paraganglioma characterized by both mass effect and endocrine activity required a "neoadjuvant" treatment to ensure safer surgical management.

TAKE-HOME MESSAGE

The percutaneous reduction of blood supply to tumoral mass could represent an effective strategy to guarantee a radical excision without major complications.

Bladder paraganglioma: basic characteristics and new perspectives on perioperative management

PURPOSE

Paraganglioma and pheochromocytoma are rare neuroendocrine tumors with severe metabolic and cardiovascular complications. Bladder PGLs are rare, and their clinical management is not precise. Here, we discuss the basic characteristics and perioperative management of bladder PGLs.

METHODS

We retrospectively reviewed 20 bladder PGL cases diagnosed at Sun Yat-sen University Cancer Center. Case notes were reviewed, clinical presentations, therapies, and outcomes were collected, and data analysis was performed.

RESULTS

Ten male and ten female patients with a median age of 47.5 years (range 14-69 years) were included. Most patients (65%) had no symptoms, and PGL was detected incidentally during medical checkups. All patients were treated surgically; 4 (20%) underwent transurethral resection of bladder tumor (TURBT), and 16 (80%) underwent partial cystectomy. Strong intraoperative blood pressure fluctuations were observed in 13 patients (65%). Two patients who were treated preoperatively with α-receptor blockers also experienced severe intraoperative blood pressure fluctuations. Postoperative measurements of troponin I were available for 3 patients, and all were significantly elevated. All patients were diagnosed with bladder PGL on postoperative pathological examination. The median follow-up time was 51 months (range 2-147 months), and 2 patients were lost to follow-up at 1 and 3 months; 16 (88.9%) survived without recurrence, 2 patients (11.1%) experienced recurrence, and 1 patient died.

CONCLUSION

Most bladder paragangliomas are easily mistaken for bladder urothelial carcinoma, and robust hemodynamic instability during surgery might be a challenge for urologists. Postoperative monitoring of troponin I, regardless of the presence of clinical symptoms, is recommended for patients with bladder PGL.