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Punzo B, Tramontano L, Clemente A, Seitun S, Maffei E, Saba L, Nicola De Cecco C, Bossone E, Narula J, Cavaliere C, Cademartiri F. Advanced imaging of cardiac Paraganglioma: A systematic review. IJC HEART & VASCULATURE 2024; 53:101437. [PMID: 39228979 PMCID: PMC11368599 DOI: 10.1016/j.ijcha.2024.101437] [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: 03/13/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 09/05/2024]
Abstract
Background and aims Cardiac ParaGangliomas (PGLs) are rare extra-adrenal tumours that arise from chromaffin cells of the sympathetic ganglia. PGL are often diagnosed incidentally, with no symptoms or symptoms related to cardiovascular dysfunction. Methods Cardiac Computed Tomography (CCT) and Cardiac Magnetic Resonance (CMR) can detect the correct morphology and position of the lesion and provide proper tissue characterization.Nuclear medicine imaging, with Positron Emission Tomography (PET) or Single Photon Emission Computed Tomography (SPECT) with specific radiotracers, can evaluate the functionality of the PGL and to distinguish a secreting from a non-secreting tumour. Results In association with biochemical parameters, a multimodal imaging approach, not yet standardized, can be useful both in the diagnosis, in the monitoring and in the treatment planning. Conclusions In this systematic review, we aim to investigate the role of diagnostic imaging, in particular CCT, CMR, PET and SPECT in diagnosis, characterization and monitoring of cardiac PGLs.
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Affiliation(s)
- Bruna Punzo
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, Naples I-80143, Italy
| | | | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio/CNR, Pisa, Italy
| | - Sara Seitun
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Erica Maffei
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, Naples I-80143, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Carlo Nicola De Cecco
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital-Emory Healthcare, Atlanta, GA, USA
| | - Eduardo Bossone
- Department of Public Health, “Federico II” University of Naples, Naples, Italy
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA
| | - Carlo Cavaliere
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, Naples I-80143, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio/CNR, Pisa, Italy
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Cutaia A, Gaetani C, Fonio P, Faletti R. Role of integrated imaging in the diagnosis of an atypical and unresectable cardiac paraganglioma: a case report. Eur Heart J Case Rep 2023; 7:ytad363. [PMID: 37554962 PMCID: PMC10406452 DOI: 10.1093/ehjcr/ytad363] [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: 11/09/2022] [Revised: 12/08/2022] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Paragangliomas (PGLs) are rare neuroendocrine tumours that originate from extra-adrenal location. Cardiac PGLs can cause severe hypertension, palpitations, and lethal tachyarrhythmias. Diagnosis is based on measurement of plasma or urine metanephrines combined with conventional and nuclear imaging. Effective treatment is represented by surgical resection. We report a case of a 19-year-old patient with recurrent acute pericarditis; integrated imaging detected a large cardiac mass suggestive for PGL. CASE SUMMARY A 19-year-old male suffered pleuritic chest pain and fever for 4 days; electrocardiogram showed inferior ST elevation and transthoracic echocardiography a 2.2 cm pericardial effusion; these findings led to diagnose acute pericarditis. After a relapse of pericarditis, cardiac magnetic resonance and cardiac computed tomography (CCT) were performed, revealing a cardiac mass with radiological features of PGL. Blood and urine tests detected elevated levels of 3-methoxytyramine and chromogranin A. Gallium-68 positron emission tomography confirmed high metabolic activity of the mass. A negative 123-I-MIBG scintigraphy ruled out the possibility of radiometabolic treatment. A second CCT excluded the chance of surgical resection, due to intra-lesional course of the left anterior descending coronary artery. The young patient was referred to a different centre to achieve reduction of the mass, in order to potentially resect it afterwards. DISCUSSION Cardiac PGLs are rare tumours with significant morbidity related to norepinephrine secretion. In this case, without typical clinical manifestations and with no chance of surgical resection, integrated imaging played a central role in the differential diagnosis between PGL and other cardiac masses, providing both static and dynamic characterization.
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Affiliation(s)
- Aldo Cutaia
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
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A case with primary cardiac paraganglioma: imaging findings. Radiol Case Rep 2022; 17:1280-1283. [PMID: 35242252 PMCID: PMC8857537 DOI: 10.1016/j.radcr.2021.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
Abstract
A 67-yeary-old middle-aged woman admitted to the hospital with chief complaints of intermittent palpitation, fatigue for more than 3 months, and bilateral lower extremity edema about 2 months. A solid mass was discovered in the right atrium by echocardiographic examination, and computerized tomography (CT) guided needle biopsy of the mass was performed and revealed a neurogenic tumor, which was a paraganglioma. She underwent surgical excision of the tumor and had uneventful recovery at a month post-operation.
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Cardiac paragangliomas: A case series with clinicopathologic features and succinate dehydrogenase B immunostaining. Ann Diagn Pathol 2020; 45:151477. [PMID: 32062474 DOI: 10.1016/j.anndiagpath.2020.151477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 11/23/2022]
Abstract
Cardiac paragangliomas (PGs) are very rare tumors that comprise less than 1% of all cardiac tumors. PGs can occur sporadically, but inherited syndromes may also play a role in the development of PGs. Approximately one-third of PGs are associated with mutations in the succinate dehydrogenase (SDH) complex, specifically SDHB, as part of syndrome-associated PGs or sporadic PGs. SDH mutations have been assessed by SDHB immunohistochemistry, as negative staining indicates a high likelihood of mutation in PGs in other sites, but not in cardiac PGs. This study aims to evaluate the clinical and pathologic characteristic of cardiac PG cases and assess the expression of SDHB by immunohistochemistry. A retrospective chart analysis of 10 patients with cardiac PG was performed to assess the patient age, sex, size, site of the tumor, and clinical symptoms. Histologically the tumors showed the classic pattern of nested tumor cells surrounded by sustentacular cells. Immunohistochemistry for SDHB was performed in five cases. One case showed a complete absence of SDHB immunohistochemical staining and the others showed staining ranging from a weak-to-strong granular cytoplasmic staining pattern. We conclude that SDHB immunostaining is cost-effective in identifying cases with SDH mutation. It is recommended to assess SDH mutation in patients with cardiac PG to predict the aggressive behavior that has been reported by previous studies from PGs of other sites.
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Bansal N, Walters HL, Aggarwal S. Cardiac Paraganglioma in a 14-Year-Old. World J Pediatr Congenit Heart Surg 2019; 12:433-436. [PMID: 31088210 DOI: 10.1177/2150135118824077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac paraganglioma (PGL) is a rare catecholamine-secreting tumor forming 1% to 3% of cardiac tumors. Although most PGL occur sporadically, evidence exists that 40% of them may be related to familial cancer predisposition syndromes. We present a unique case of a 14-year-old female who presented with persistent hypertension and was found to have a cardiac PGL. During surgical resection, even though the main right coronary was preserved, the sinoatrial (SA) nodal artery was surrounded by the tumor and required resection with the tumor. The patient subsequently developed SA node dysfunction and is currently being evaluated for placement of a permanent pacemaker.
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Affiliation(s)
- Neha Bansal
- Division of Cardiology, 2969Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Henry L Walters
- Division of Cardiothoracic Surgery, 2969Children's Hospital of Michigan, Detroit, MI, USA
| | - Sanjeev Aggarwal
- Division of Cardiology, 2969Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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Primary unresectable locally invasive biatrial paraganglioma presenting with chest pain. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Primary cardiac tumors associated with genetic syndromes: a comprehensive review. Pediatr Radiol 2018; 48:156-164. [PMID: 29214333 DOI: 10.1007/s00247-017-4027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 11/03/2017] [Indexed: 12/30/2022]
Abstract
Various cardiac tumors occur in the setting of a genetic syndrome such as myxomas in Carney complex and rhabdomyomas in tuberous sclerosis. Tumor biology can be different in syndromic forms, and on imaging children sometimes demonstrate additional manifestations of the underlying syndrome. We discuss the imaging appearance of cardiac tumors occurring in the framework of a genetic syndrome, the findings that suggest an underlying syndrome, and the impact on management.
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Spencer D, Evans M, Wang B, Delrosario JL, Cheng T, Milliken J. Unusual cardiac paraganglioma mimicking an atypical carcinoid tumor of the lung. J Thorac Dis 2018; 10:E31-E37. [PMID: 29600100 DOI: 10.21037/jtd.2017.11.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a case of unusual cardiac paraganglioma (PG) initially misdiagnosed as atypical carcinoid tumor of the lung and discuss key clinical and pathologic characteristics that guide surgical management of these rare chromaffin cell tumors. A 64-year-old female with persistent cough and back pain was found to have a 4 cm × 3 cm mass abutting multiple cardiopulmonary structures. A biopsy was performed at an outside institution and pathology reported "atypical neuroendocrine carcinoma, consistent with carcinoid". The patient was transferred to our institution and pericardial resection with right pneumonectomy was performed to excise the tumor. Histology of the mass was that of PG with multiple ethanol embolizations. Immunohistochemical examination revealed that type I (chief) cells were positive for neuroendocrine markers (chromogranin A and synaptophysin), while type II (sustentacular) cells were positive for S100. There was no evidence of atypical carcinoid tumor in the lung. PG is an entity of chromaffin cell tumors that often affects the adrenal glands and carotid body. PG rarely occurs in the thoracic region, accounting for just 1-2% of all PG. Proper diagnosis of cardiac PG is challenging owing to its rare prevalence, subtle symptoms of presentation, and the neuroendocrine histopathological features it shares with atypical carcinoids. These tumors are typically benign and are best treated by surgical resection. Our report examines the approach to appropriate diagnosis of cardiac PG vs. atypical carcinoid, preoperative management, and surgical treatment by describing successful resection through thoracotomy without the use of cardiopulmonary bypass.
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Affiliation(s)
- Dean Spencer
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Mark Evans
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - Beverly Wang
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - J Lawrence Delrosario
- Department of Surgery, Division of Cardiothoracic Surgery, University of California Irvine, Irvine, CA, USA
| | - Timmy Cheng
- Department of Medicine, Division of Pulmonology and Critical Care, University of California Irvine, Irvine, CA, USA
| | - Jeffrey Milliken
- Department of Surgery, Division of Cardiothoracic Surgery, University of California Irvine, Irvine, CA, USA
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Bhojwani N, Huang J, Garg V, Yang M, Oliveira GH, Rajiah P. Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging in the Diagnosis of Cardiac Paraganglioma. Indian J Nucl Med 2017; 32:380-382. [PMID: 29142369 PMCID: PMC5672773 DOI: 10.4103/ijnm.ijnm_93_17] [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] [Indexed: 11/09/2022] Open
Abstract
Cardiac paragangliomas are rare tumors of neural crest origin, most frequently seen in the left atrium. There are mixed opinions regarding the most appropriate imaging study for diagnosis and evaluation. We describe the novel utility of 18-F-Fluorodeoxyglucose positron emission tomography/magnetic resonance imaging in the case of a 42-year-old male with cardiac paraganglioma.
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Affiliation(s)
- Nicholas Bhojwani
- Division of Musculoskeletal Radiology, Medical Diagnostic Imaging Group, Phoenix, AZ 85029, USA
| | - Jennifer Huang
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Vasant Garg
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michael Yang
- Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Guilherme H Oliveira
- Department of Cardiology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Prabhakar Rajiah
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
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Marchand L, Garby L, Nozières C, Raverot G, Borson-Chazot F. An old retrocardiac mass fortuitously reclassified as paraganglioma. ANNALES D'ENDOCRINOLOGIE 2016; 77:668-669. [PMID: 27788913 DOI: 10.1016/j.ando.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Lucien Marchand
- Department of endocrinology, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Laetitia Garby
- Department of endocrinology, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Cécile Nozières
- Department of endocrinology, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Gérald Raverot
- Department of endocrinology, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Françoise Borson-Chazot
- Department of endocrinology, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France.
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Saththasivam P, Herrera E, Jabbari OA, Reardon M, Sheinbaum R. Cardiac Paraganglioma Resection With Ensuing Left Main Coronary Artery Compromise. J Cardiothorac Vasc Anesth 2016; 31:236-239. [PMID: 27569826 DOI: 10.1053/j.jvca.2016.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Poovendran Saththasivam
- Department of Cardiothoracic and Vascular Anesthesiology, University of Texas Health Science Center at Houston, Houston, TX.
| | - Elizabeth Herrera
- Department of Cardiothoracic and Vascular Anesthesiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Odeaa Al Jabbari
- Cardiothoracic and Vascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Michael Reardon
- Cardiothoracic and Vascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Roy Sheinbaum
- Department of Cardiothoracic and Vascular Anesthesiology, University of Texas Health Science Center at Houston, Houston, TX
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