Rare and complicated functional posterior mediastinal paraganglioma. BMJ Case Rep 2022 Jun 07;15(6)
Date
06/08/2022Pubmed ID
35672059Pubmed Central ID
PMC9174829DOI
10.1136/bcr-2022-250500Scopus ID
2-s2.0-85131479764 (requires institutional sign-in at Scopus site) 1 CitationAbstract
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.
Author List
SenthilKumar G, Rokkas CK, Sheinin YM, Linsky PLAuthors
Paul L. Linsky MD Assistant Professor in the Surgery department at Medical College of WisconsinYuri M. Sheinin MD, PhD Associate Professor in the Pathology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
CatecholaminesHumans
Male
Mediastinal Neoplasms
Mediastinum
Paraganglioma
Paraganglioma, Extra-Adrenal
