Primary Paraganglioma of the Lung in an Asymptomatic Patient

Abstract

Arising from the autonomic paraganglia of the neuroendocrine system, paragangliomas are rare neoplasms that are derived from the embryonic neural crest. Primary paragangliomas of the lung are exceedingly rare, with little known about their origin. Here we present a 47-year-old female presenting in 2021, one year after a COVID-19 infection, with symptoms of tachycardia, shortness of breath, and palpitations which she associated with presumed long COVID-19. An imaging workup noted a 1.5 cm nodule in the lingula of the left lung. She then had surgical resection of the nodule, which was found to be a primary lung paraganglioma. A follow-up dotatate positron emission tomography (PET) CT noted no residual disease, and genetic testing was negative for known mutations. This case demonstrates the need for close monitoring with follow-up for incidental findings in order to provide a timely and accurate diagnosis in accordance with guideline criteria.

Keywords: incidentaloma; neuroendocrine tumor; paraganglioma; pheochromocytoma; suspicious lung mass.

Figure 1. Computerized tomography of the chest in 2014 showing a 4 mm left upper lobe lingular lung nodule

Figure 2. Computerized tomography of the chest in 2021 showing an increase in the lung nodule size to 15 mm

Figure 3. Positive emission tomography scan of the chest showing no uptake of I-123 in the left upper lobe lingular nodule

Figure 4. Immunohistochemistry stain showing positive chromogranin

Figure 5. S-100 stain showing sustentacular cells