A 45-year-old woman with a posterior mediastinal tumor underwent right thoracotomy for resection, developing hypertension and difficult-to-control tachycardia while the tumor was being manipulated. A catecholamine-secreting tumor was suspected, the operation halted, and the patient prepared for surgery at a later time. The tumor was a mediastinal paraganglioma and the final outcome was satisfactory. Risk related to anesthesia is high in such patients, with perioperative mortality ranging from 40 to 85%. Correct diagnosis and appropriate preoperative drug preparation with adrenergic receptor blockers appreciably decreases morbidity and mortality related to surgery. We discuss the effect of labetalol on such tumors and describe our observations.
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Int J Surg Case Rep
January 2025
Department of Thoracic surgery, National University Hospital, Damascus University, Damascus, Syria.
Introduction: Mediastinal paragangliomas are rare neoplasms arising from extra-adrenal neural crest cells, presenting as either functional or nonfunctional tumors. Clinical manifestations range from catecholamine-related symptoms to physical compression effects. Accurate recognition of these tumors is crucial for diagnosis and management due to their rarity and association with vital mediastinal structures.
View Article and Find Full Text PDFJ Cardiothorac Surg
January 2025
Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China.
Background: Paragangliomas are rare neoplasms arising from extra-adrenal chromaffin cells, with mediastinal paragangliomas representing an exceptionally rare subset. This report details the surgical management of a complex mediastinal paraganglioma case, presenting with refractory hypertension and invasion of critical surrounding structures. A comprehensive review of the current literature is included to underscore existing cases, enhance clinical awareness, and share our insights and experience in the diagnosis and treatment of this challenging condition.
View Article and Find Full Text PDFMedicine (Baltimore)
December 2024
Department of Urology, Gansu Provincial Hospital, Lanzhou, China.
Rationale: Pheochromocytomas typically arise in the adrenal medulla, whereas ectopic pheochromocytomas/paragangliomas commonly occur near the abdominal aorta, bladder, mediastinum, and head. Diaphragmatic pheochromocytomas are exceedingly rare, and there is limited surgical experience with their treatment.
Patient Concerns: In Case A, the subject is a 45-year-old male, while in Case B, the subject is a 59-year-old female.
J Surg Case Rep
December 2024
Department of Thoracic Surgery, Morristown Medical Center, Morristown, NJ 07960, United States.
Paragangliomas are rare neuroendocrine tumors originating from extra-adrenal paraganglia that often require intricate surgical resection. Specifically, when paragangliomas are localized within the thorax and coexist with cardiovascular structures, they can be challenging to surgically resect. Here, we aimed to review three cases of paragangliomas intruding the aortopulmonary (AP) window that required cardiopulmonary bypass (CPB) as an effective surgical approach.
View Article and Find Full Text PDFCureus
October 2024
Cardiothoracic Surgery, Northeast Georgia Medical Center Gainsville, Gainesville, USA.
Mediastinal paragangliomas, though rare, present significant surgical challenges due to their proximity to critical vascular structures within the mediastinum. This case report discusses the management of a patient with an incidentally discovered non-functional mediastinal paraganglioma. The tumor's location necessitated meticulous preoperative planning and intraoperative navigation to prevent vascular injury.
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