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Stiru O, Dragan A, Adamache C, Dragulescu PR, Stiru C, Tulin A, Bacalbasa N, Balescu I, Diaconu C, Geana RC, Savu C, Iliescu VA. Abdominal paraaortic paraganglioma: Management of intraoperative hemodynamic emergencies during elective resection procedures (A case presentation). Exp Ther Med 2021; 21:543. [PMID: 33815616 DOI: 10.3892/etm.2021.9975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
Paragangliomas are extremely rare neuroendocrine tumors. We report a case of a 44-year-old man with hypertension who presented a tumoral mass located retroperitoneally at the aortic bifurcation which included both the common iliac arteries and the posterior left iliac vein, who experienced an unpredictable intraoperative cardiac arrest with electromechanical dissociation at 5 min after laparotomy. After successful resuscitation and hemodynamic stability, the lesion was fully excised. In the course of tumor manipulation, the patient developed a major hypertensive crisis with peak systolic blood pressure over 280 mmHg. Pathologic examination revealed the presence of diffuse proliferation of large and medium-sized mature adipocytes consistent with paraganglioma diagnosis. The patient was discharged at home on the seventh postoperative day. He did not present evidence of recurrence at the one-year follow-up. In conclusion, paragangliomas can require particular management due to their location but also due to their capacity to discharge substances which might induce life-threatening intraoperative complications.
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Affiliation(s)
- Ovidiu Stiru
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Dragan
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Cristina Adamache
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Petru Razvan Dragulescu
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Carmen Stiru
- Department of Neurology, 'Prof. Dr. Agripa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, 'Prof. Dr. Agripa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Roxana Carmen Geana
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania
| | - Vlad Anton Iliescu
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Samara AA, Diamantis A, Symeonidis D, Anagnostou A, Diamantis AM, Mavrovounis G, Tepetes K. Asymptomatic Presacral Paraganglioma: Management of an Unpredictable Intraoperative Finding. Surg J (N Y) 2020; 6:e131-e134. [PMID: 32626824 PMCID: PMC7326578 DOI: 10.1055/s-0040-1712545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
Paragangliomas are rare neuroendocrine tumors originating from the embryological neural crest. We report a rare case of a patient with an asymptomatic presacral mass (incidentaloma) who experienced an unpredictable intraoperative hypertensive crisis after manipulation of the tumor. Presacral neoplasms pose a diagnostic and therapeutic challenge due to their obscure anatomical location and the difficulty in performing an R0 excision. Furthermore, the management of asymptomatic paragangliomas requires a high level of clinical suspicion and expertise due to potential life-threatening intraoperative complications.
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Affiliation(s)
- Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Kumar S, Choudhary GR, Singh S, Prasad S, Singh SK, Bhansali A, Bhadada S, Dutta P. Spectrum of retroperitoneal and genitourinary paraganglioma: Experience at a North Indian tertiary care center. Cent European J Urol 2016; 68:421-7. [PMID: 26855794 PMCID: PMC4742435 DOI: 10.5173/ceju.2015.600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction Genitourinary and retroperitoneal paragangliomas are infrequent tumors with bizarre presentation. A high index of suspicion is required to make a diagnosis in young hypertensive individuals. Our aim is to study the varied clinical presentations and management of these paragangliomas. Herein, we share our experience of clinical presentation, diagnosis, and management of these paragangliomas. Material and methods Seventeen consecutive patients who underwent surgery for paraganglioma at our institute from August 2009 to July 2014 were included. Demographic, peri-operative, surgical, and follow up data were collected and analyzed. Results Mean age of presentation was 34.8 years with female predominance. The majority of the tumors were located in the retroperitoneum and urinary bladder. Most of them presented with classical symptoms of catecholamine excess and hypertension. Complete surgical resection could be performed in 13 cases. At a median follow up of two years, cases with R0 resection (no microscopic malignant cells) did not show recurrence. Among patients on chemotherapy, one died, another had partial response, and yet another had progressive disease. Conclusions Genitourinary and retroperitoneal paragangliomas are a disease of a young age group with variable clinical features at presentation. Appropriate pre-operative optimization and complete surgical resection provide the best chance of cure.
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Affiliation(s)
- Santosh Kumar
- Post Graduate Institute of Medical Education and Research, Department of Urology, Chandigarh, India
| | - Gautam Ram Choudhary
- Post Graduate Institute of Medical Education and Research, Department of Urology, Chandigarh, India
| | - Shivanshu Singh
- Post Graduate Institute of Medical Education and Research, Department of Urology, Chandigarh, India
| | - Seema Prasad
- Post Graduate Institute of Medical Education and Research, Department of Anesthesia, Chandigarh, India
| | - Shrawan Kumar Singh
- Post Graduate Institute of Medical Education and Research, Department of Urology, Chandigarh, India
| | - Anil Bhansali
- Post Graduate Institute of Medical Education and Research, Department of Endocrinology, Chandigarh, India
| | - Sanjay Bhadada
- Post Graduate Institute of Medical Education and Research, Department of Endocrinology, Chandigarh, India
| | - Pinaki Dutta
- Post Graduate Institute of Medical Education and Research, Department of Endocrinology, Chandigarh, India
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