Paraganglioma of the mediastinum: challenges in diagnosis and surgical management

Abstract

Mediastinal paraganglioms are rare, highly vascularized tumors arising from chromaffin tissue located in the para-aortic ganglia. Tumors tend to invade bordering structures and may also form metastasis. Up to 50% of patients are asymptomatic and diagnosis is incidental. Presenting symptoms are related to catecholamine hypersecretion or to a mass effect. Complete surgical resection remains the standard of care due to malignant potential of the tumor and poor response to chemotherapy or radiation. Strategic location of the tumor in proximity to great vessels, trachea, and recurrent laryngeal nerve poses challenge for the surgeon. We report a case of a 59-year old asymptomatic female who was incidentally diagnosed with a middle mediastinal mass on a positron-emission tomography (PET-CT) scan performed as part of breast cancer surveillance. Complete resection of the tumor was achieved using cardiopulmonary bypass. The patient recovered uneventfully and in a ten-month follow up there is no evidence of recurrence.

Figure 1

A - PET CT scan image showing a middle mediastinal mass of 5 cm in diameter with an SUV of 20. B, C - Axial and coronal CT scan images showing the tumor (T) adjacent to the aorta (Ao) and pulmonary artery (PA). The compressed superior vena cava is seen in coronal view (SVC).

Figure 2

A - Intraoperative view: the tumor (T) is seen between the aorta (Ao) and superior vena cava (S). Right atrium (RA) Right ventricle (RV). B - resected tumor is shown.