Spinal impostor: Metastatic cervical paraganglioma presenting with paraparesis, a case report

Abstract

Introduction and importance: Paragangliomas are rare neuroendocrine tumors, typically arising from extra-adrenal chromaffin cells. Primary intra-spinal paragangliomas are uncommon, and metastatic spinal paragangliomas without paraneoplastic symptoms are even rarer. This case highlights the diagnostic challenges posed by such rare tumors.

Case presentation: A 28-year-old male soldier from the Comoros Islands presented with a neck mass, initially suspected to be Hodgkin's lymphoma based on imaging. Biopsy of two cervical nodes revealed reactive lymphadenopathy. Later, he developed progressive lower limb weakness and numbness, prompting further investigation. Imaging showed an extradural spinal tumor at T6 with cord compression. Laminectomy and tumor excision relieved compression, revealing a highly vascularized tumor. Histopathology and immunohistochemistry confirmed a paraganglioma, which was consistent with the metastatic nature confirmed by a repeat biopsy of the neck mass.

Clinical discussion: Metastatic spinal paragangliomas are rare and challenging to diagnose, especially without paraneoplastic symptoms. This case underscores the importance of thorough histopathological evaluation when spinal lesions and neck masses present with unusual features and highlights the need for a multidisciplinary approach.

Conclusion: This case emphasizes the diagnostic difficulty of metastatic spinal paragangliomas, particularly when they mimic more common conditions like Hodgkin's lymphoma. It stresses the importance of considering rare differential diagnoses and a collaborative approach to managing such cases.

Keywords: Carotid body tumor; Case report; Diagnostic uncertainty; Neoplastic cord compression; Spinal paraganglioma.

Fig. 1

Cervical MRI images, T1 FS with contrast Axial demonstrating the vessel encasing left carotid paraganglioma.

Fig. 2

Thoracic spine MRI with contrast, T1 FS Sagittal demonstrating T6 spinal veterbra metastasis with cord compression.

Fig. 3

H & E neck mass (Carotid body) showing Tumor in nests and sheets of uniform atypical cells separated by delicate fibrovascular cores (Zellballen Pattern-blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

H&E Spinal metastasis; (low power)-Sections show a tumor in nested/zellballen pattern separated by delicate fibrovascular cores.

Fig. 5

Chromogranin Immunohistochemistry staining with high power showing strong and diffuse staining of tumor cells for chromogranin.

Fig. 6

Intra-operative images of spine metastasis resection.