RESUMO
The patient, a 40-year-old woman, was diagnosed as having a functional right vagal paraganglioma (PGL) 15 years after undergoing resection for a retroperitoneal PGL. 123I-MIBG scintigraphy showed no accumulation, but as the blood noradrenaline and urinary normetanephrine concentrations were elevated, the tumor was judged as being functional, and surgery was scheduled. The patient was started on doxazosin infusion and embolization of the tumor feeding vessel was performed before the surgery. Intraoperative examination showed that the tumor was contiguous with the vagal nerve, necessitating combined resection of the vagal nerve with the tumor. Postoperatively, the catecholamine levels returned to normal range. Histopathologically, the tumor was diagnosed as a moderately differentiated, intermediate-malignant-grade PGL, with a GAPP score of 4 to 6. No non-chromaffin tissue was observed in the tumor background, so that the functional vagal PGL was considered as a sporadic metachronous tumor rather than as a metastasis from the retroperitoneal PGL. More than half of head and neck paragangliomas (HNPGLs) are reported to arise in the carotid body, and about 5% from the vagal nerve. In addition, HNPGLs rarely produce catecholamines. Herein, we consider the relationship with the previously resected retroperitoneal PGL based on a review of the literature.
Assuntos
Paraganglioma , Neoplasias Retroperitoneais , Humanos , Feminino , Adulto , Neoplasias Retroperitoneais/cirurgia , Neoplasias Retroperitoneais/patologia , Paraganglioma/cirurgia , Paraganglioma Extrassuprarrenal/cirurgia , Paraganglioma Extrassuprarrenal/patologia , Normetanefrina/urina , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Doenças do Nervo Vago/cirurgia , Embolização Terapêutica , Norepinefrina/sangue , Nervo VagoRESUMO
We report a case of cervicofacial actinomycosis mimicking malignant sarcoma in a 78-year-old man with diabetes. High lesion uptake and decreased cerebral uptake on [18F]FDG PET/CT provide a potentially important diagnostic clue suggesting infectious disease in a poorly controlled diabetic patient.