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Case Reports
. 2013 Oct 29:13:49.
doi: 10.1186/1471-2482-13-49.

Resection of a malignant paraganglioma located behind the retrohepatic segment of the inferior vena cava

Changjun Jia, Xinlu Wang, Chaoliu Dai  1 , Xianmin Bu, Songlin Peng, Feng Xu, Yongqing Xu, Yang Zhao
Affiliations
Case Reports

Resection of a malignant paraganglioma located behind the retrohepatic segment of the inferior vena cava

Changjun Jia et al. BMC Surg. .

Abstract

Background: Resection of a retrocaval paraganglioma is technically challenging due to limited tumor accessibility and proximity to the vena cava.

Case presentation: A large, malignant paraganglioma was found behind the retrohepatic segment of the inferior vena cava of a 60-year-old male. During resection of this rare paraganglioma, the left lateral lobe of the liver, a portion of the caudate lobe of the liver, and the gallbladder were also removed. Unfortunately, the patient died six months after surgery due to hepatic metastasis.

Conclusion: This case demonstrates that a partial hepatectomy may be necessary to improve tumor accessibility during resection of a retrocaval paraganglioma, particularly if the tumor is proximal to the vena cava. Furthermore, palliative treatments may help prevent tumor recurrence and metastasis of malignant paragangliomas.

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Figures

Figure 1
Figure 1
Diagnostic imaging of the retroperitoneal paraganglioma. (A) Abdominal ultrasonography showed a retrocaval mass (indicated by arrowheads) present in the right parasagittal sonographic section. The mass compressed the IVC (indicated by an white arrow) in an anterior direction. (B) Axial contrast-enhanced CT scan showed a non-homogeneously enhanced retrocaval mass (indicated by arrowheads) with necrotic cysts. (C) Coronal contrast-enhanced CT scan showed anterior displacement and extrinsic compression of the IVC (indicated by an black arrow) by the retrocaval mass (indicated by arrowheads). (D) Postoperative abdominal US scan showed multifocal hepatic metastatic lesions (shown in blue).
Figure 2
Figure 2
Intraoperative imaging of the retroperitoneal paraganglioma. (A) The tumor (indicated by arrowheads) was found behind the retrohepatic segment of the IVC with the hepatic hilum (indicated by an white arrow) lifted in an anterior direction. (B) After the gallbladder and the hepatic left lateral lobe were resected, the IVC (indicated by an black arrow) was carefully mobilized clockwise in a cephalad and dorsal direction up to the level of the second hepatic hilum via a left lateral side approach. (C) After the tumor was removed, the IVC (indicated by an black arrow) and the prevertebral space become fully visible. (D) Specimen of the retroperitoneal paraganglioma.
Figure 3
Figure 3
Histological and immunohistochemical analyses of the retroperitoneal paraganglioma. (A) Hematoxylin and eosin staining of the resected specimen (magnification, 100×; scale bar = 100 μm). (B and C) Immunohistochemical staining for (B) S100 protein and (C) synaptophysin (magnification, 400×; scale bar = 50 μm).
See this image and copyright information in PMC

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