Management of hypertension in intrapericardial paraganglioma

Role of Multimodality Imaging and Preoperative Management in Intrapericardial Paragangliomas

Intrapericardial paragangliomas are rare, highly vascular tumors that frequently adhere to adjacent structures and blood vessels, making surgical resection challenging. In this case series, we discuss the role of multimodality imaging and preoperative embolization in the management of 3 patients presenting with intrapericardial paragangliomas. (Level of Difficulty: Advanced.)

A Clinico-Pathologic Approach to the Differential Diagnosis of Pericardial Tumors

PURPOSE OF REVIEW

Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be categorized as non-neoplastic or neoplastic. Neoplastic lesions can be further divided into benign or malignant, with malignancies being either primary or secondary (metastatic). Clinical, radiographic, and pathologic features of the most common entities are discussed.

RECENT FINDINGS

Metastatic neoplasms involving the heart and pericardium are far more common than primary pericardial neoplasms. Of primary pericardial malignancies, mesothelioma is the most common; notably, cytology of effusion fluid is relatively insensitive to the diagnosis. The prognosis for most malignancies of the pericardium, primary or secondary, is poor. Increasingly, clinically recognized diseases that involve the pericardium include Erdheim-Chester and IgG4-related disease. This article provides a comprehensive review of the most recent literature to develop a structured framework to the differential diagnosis of pericardial tumors.

Paraganglioma of the carotid body and intrapericardium

A 65-year-old Japanese woman with an intrapericardial tumor and neck tumor was admitted to our hospital. Intrapericardial tumor had not been resected because of massive bleeding from the hypervascular tumor and its invasion into the pericardium, ascending aorta, and pulmonary artery. The neck tumor had been successfully resected, and paraganglioma was pathologically diagnosed. Abnormal accumulation in the intrapericardial tumor was seen with ¹²³I-metaiodobenzylguanidine scintigraphy. Moreover, gene mutation of succinate dehydrogenase type D was found. Finally, paraganglioma of the carotid body and intrapericardium was diagnosed. <Learning objective: Cardiac paraganglioma (PGL) and simultaneous carotid body and cardiac PGL is exceedingly rare. We experienced a case of intrapericardial tumor and carotid body tumor, evaluated by histological examination of the surgical specimen of the carotid body tumor and multimodal imaging including ¹²³I-metaiodobenzylguanidine scintigraphy, and genetic analysis of the succinate dehydrogenase gene. The final diagnosis was type 1 PGLs of both the carotid body and intrapericardium.>.