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Case Reports
. 2010 Jan 4;12(1):1.
doi: 10.1186/1532-429X-12-1.

Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma

Anderanik Tomasian  1 , Chi Lai, Stefan Ruehm, Mayil S Krishnam
Affiliations
Case Reports

Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma

Anderanik Tomasian et al. J Cardiovasc Magn Reson. .

Abstract

Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization.

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Figures

Figure 1
Figure 1
Axial view of PET-CT scan image demonstrates a large hypermetabolic mass with intense uptake of F18 Levo-DOPA in the posterior mediastinum near the left atrium which is consistent with paraganglioma.
Figure 2
Figure 2
Horizontal long axis CMR images demonstrate a round, well defined posterior mediastinal mass with smooth extrinsic compression of left atrial wall which is hypo-intense on breath-hold Steady State Free Precession (SSFP) cine CMR (a, arrow), and shows homogenously high signal on T2-weighted dark blood turbo spin-echo image (b, arrow). T1-weighted inversion recovery gradient-echo myocardial perfusion imaging demonstrates heterogeneous, mostly peripheral, dynamic contrast filling of the mass suggesting vascularity (c, arrow), and T1-weighted, fat-saturated, inversion recovery late gadolinium enhancement image shows peripheral rim enhancement with no evidence of central enhancement suggestive of central tissue necrosis (d, arrow).
Figure 3
Figure 3
(A) Low power photomicrograph (40×; H&E stain) demonstrates tumor (*) compressing left atrium (LA). (B) The tumor is comprised of nests of fairly uniform cells with moderate eosinophilic, granular cytoplasm (200×; H&E stain). (C) Marked cytologic atypia with pleomorphic nuclei and prominent nucleoli was focally present (400×; H&E stain) in addition to (D) increased number of mitoses (arrows) (400×; H&E stain). (E) Scattered foci of coagulative tumor necrosis (N) were also noted (200×; H&E stain). (F) The tumor exhibited diffuse, strong cytoplasmic positivity for synaptophysin immunostain (400×). (G) S100 immunostain highlights sustentacular cells surrounding nests of tumor cells (400×).
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