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Case Reports
. 2022 Jun 7;15(6):e250500.
doi: 10.1136/bcr-2022-250500.

Rare and complicated functional posterior mediastinal paraganglioma

Gopika SenthilKumar  1 , Chris K Rokkas  1 , Yuri M Sheinin  2 , Paul L Linsky  3
Affiliations
Case Reports

Rare and complicated functional posterior mediastinal paraganglioma

Gopika SenthilKumar et al. BMJ Case Rep. .

Abstract

Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by catecholamine-related symptoms, involvement of cardiac structures and/or tumour supply from major blood vessels. We report a case of a man in his 30s with a subcarinal functional PG complicated by all three factors. The PG had arterial supplies from the right coronary and bronchial arteries, with mass effect on the left atrium. Given the high risk of intraoperative bleeding, catecholamine surges and injury to right coronary artery, we attempted a minimally invasive strategy that incorporates best practices from the few published cases on functional PGs. We show that a multidisciplinary approach involving alpha/beta blockade, preoperative embolisation of tumour blood supply, robotic-assisted tumour mobilisation and, if needed, open resection with cardiopulmonary bypass can be a safe strategy in the treatment of functional mediastinal paragangliomas adherent to cardiac structures.

Keywords: Cardiothoracic surgery; Endocrine cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Lateral and (B) axial chest CT angiography.
Figure 2
Figure 2
PET GA68 Dotatate scan.
Figure 3
Figure 3
(A) Right coronary artery angiogram and (B) embolisation.
Figure 4
Figure 4
(A) Gross specimen, (B) H&E staining, (C) synaptophysin (+), (D) chromogranin (+) and (E) Cytokeratin AE1/AE3 (−) 20× magnification.
See this image and copyright information in PMC

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