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1.
A A Pract ; 15(11): e01542, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34735416

RESUMO

Nociception is the detection of noxious stimulation by the nervous system. The PMD-200 monitor is a validated, emerging technology for intraoperative monitoring using the nociception level (NOL) index. We describe a pediatric case of an open resection of paraganglionic masses during which episodic increases in NOL index and blood pressure coincided with tumor manipulation, presumably due to a catecholamine surge. Since the patient was under stable and adequate analgesia, the increases in NOL index likely reflected the physiologic effects of tumor handling rather that the presence of a true noxious stimulus. Clinicians should consider this limitation when using this monitor.


Assuntos
Nociceptividade , Paraganglioma , Criança , Humanos , Monitorização Intraoperatória , Medição da Dor , Paraganglioma/cirurgia , Remifentanil
2.
BMJ Case Rep ; 14(10)2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663632

RESUMO

A 31-year-old Caucasian woman underwent a standard workup as a potential kidney transplant donor. Kidney donor protocol CT showed a left para-aortic hypervascular mass suspicious for a paraganglioma. Biochemical workup revealed elevated urinary catecholamines, supporting this suspicion. The patient underwent surgical resection with histopathological evaluation that confirmed the diagnosis. Endocrine evaluation 2 years later revealed a family history of a cousin with a history of pheochromocytoma as a teenager. A genetic panel identified a missense mutation in succinate dehydrogenase C (c.202T>C; p.Ser68Pro), which was described as a variant of unknown significance. In silico analysis suggested that it may be a deleterious mutation. We concluded that this mutation may be pathogenic, considering these supporting pieces of evidence and her early-onset paraganglioma. This report highlights the importance of genetic screening in patients with paragangliomas/pheochromocytomas, since many cases are familial. Additionally, it underscores the importance of evaluating and documenting cases of variants of unknown significance.


Assuntos
Neoplasias das Glândulas Suprarrenais , Paraganglioma , Feocromocitoma , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Feminino , Testes Genéticos , Humanos , Mutação de Sentido Incorreto , Paraganglioma/diagnóstico por imagem , Paraganglioma/genética , Paraganglioma/cirurgia , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/genética , Feocromocitoma/cirurgia
3.
World J Gastroenterol ; 27(37): 6322-6331, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34712035

RESUMO

BACKGROUND: Pancreatic paragangliomas (PPGL) are rare benign neuroendocrine neoplasms but malignancy can occur. PPGL are often misdiagnosed as pancreatic neuroendocrine tumor or pancreatic adenocarcinoma. CASE SUMMARY: We reviewed 47 case reports of PPGL published in PubMed to date. Fifteen patients (15/47) with PPGL underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Only six (6/15) were correctly diagnosed as PPGL. All patients with PPGL underwent surgical resection except three (one patient surgery was aborted because of hypertensive crisis, two patients had metastasis or involvement of major vessels). Our patient remained on close surveillance as she was asymptomatic. CONCLUSION: Accurate preoperative diagnosis of PPGL can be safely achieved by EUS-FNA with immunohistochemistry. Multidisciplinary team approach should be considered to bring the optimal results in the management of PPGL.


Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Paraganglioma , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia
4.
Medicina (Kaunas) ; 57(10)2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34684070

RESUMO

In some subjects with inherited pheochromocytoma/paraganglioma (PPG) syndromes, hypoxia-inducible factor 1 alpha (HIF1α) stabilization/activation could lead to an increase in angiotensin converting enzymes (ACE). This would result in the stimulation of angiotensin (AT) II production and, hence, reduce the availability of ACE 2. The latter would provide decreased numbers of binding sites for the spike protein of SARS-CoV-2 and, therefore, result in less points of viral entry into cells. Thus, subjects with HIF1α-associated PPG syndromes may benefit from an inherent protective effect against COVID-19. Such an implication of HIF1α vis-à-vis COVID-19 could open ways of therapeutic interventions.


Assuntos
Neoplasias das Glândulas Suprarrenais , COVID-19 , Paraganglioma , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/genética , Inibidores da Enzima Conversora de Angiotensina , Humanos , Paraganglioma/genética , Feocromocitoma/genética , SARS-CoV-2 , Síndrome
6.
AJNR Am J Neuroradiol ; 42(10): 1847-1852, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34503944

RESUMO

BACKGROUND AND PURPOSE: Accurate differentiation of paragangliomas and schwannomas in the jugular foramen has important clinical implications because treatment strategies may vary but differentiation is not always straightforward with conventional imaging. Our aim was to evaluate the accuracy of both qualitative and quantitative metrics derived from dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel MR imaging to differentiate paragangliomas and schwannomas in the jugular foramen. MATERIALS AND METHODS: A retrospective study of imaging data was performed on patients (n = 30) undergoing MR imaging for jugular foramen masses with the golden-angle radial sparse parallel MR imaging technique. Imaging data were postprocessed to obtain time-intensity curves and quantitative parameters. Data were normalized to the dural venous sinus for relevant parameters and analyzed for statistical significance using a Student t test. A univariate logistic model was created with a binary output, paraganglioma or schwannoma, using a wash-in rate as a variable. Additionally, lesions were clustered on the basis of the wash-in rate and washout rate using a 3-nearest neighbors method. RESULTS: There were 22 paragangliomas and 8 schwannomas. All paragangliomas demonstrated a type 3 time-intensity curve, and all schwannomas demonstrated a type 1 time-intensity curve. There was a statistically significant difference between paragangliomas and schwannomas when comparing their values for area under the curve, peak enhancement, wash-in rate, and washout rate. A univariate logistic model with a binary output (paraganglioma or schwannoma) using wash-in rate as a variable was able to correctly predict all observed lesions (P < .001). All 30 lesions were classified correctly by using a 3-nearest neighbors method. CONCLUSIONS: Paragangliomas at the jugular foramen can be reliably differentiated from schwannomas using golden-angle radial sparse parallel MR imaging-dynamic contrast-enhanced imaging when imaging characteristics cannot suffice.


Assuntos
Forâmen Jugular , Neurilemoma , Paraganglioma , Meios de Contraste , Humanos , Imageamento por Ressonância Magnética , Neurilemoma/diagnóstico por imagem , Paraganglioma/diagnóstico por imagem , Estudos Retrospectivos
7.
J Ayub Med Coll Abbottabad ; 33(3): 532-534, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34487673

RESUMO

A thirty-year-old male presented with progressive hoarseness and dysphagia for solids. Fibre optic laryngoscopy showed a right supraglottic mass. Subsequent CT imaging showed the location and extent of the mass. Biopsy revealed a Paraganglioma with cytokeratin negative and chromogranin positive cells. The mass was subsequently removed without complications. Follow up also showed no complications. Hoarseness and dysphagia resolved following tumour excision.


Assuntos
Transtornos de Deglutição , Neoplasias Laríngeas , Paraganglioma , Adulto , Biópsia , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Laringoscopia , Masculino , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia
8.
Ann Ital Chir ; 92: 465-470, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34569475

RESUMO

BACKGROUND: Paragangliomas (PGL) are neuroendocrine tumors arising from neural crest-derived chromaffin cells in the parasympathetic ganglia or in sympathetic ganglia located in the adrenal glands (Pheochromocytoma, PHEO), or extra-adrenal location and around 30-40% of PGL can be hereditary (MEN2, Von Hippel Lindau syndrome, von Reklingausen syndrome and Pheochromocytoma-Paraganglioma syndrome). METHODS: We retrospectively evaluate 127 patients with PHEO/PGL treated at our Institution from 1992 to 2018 and report our experience, focusing on different surgical treatment based on hereditary syndrome. Genetic analysis was performed in patients with features suspected for hereditary syndrome to search genetic mutations of RET, VHL, SDHD and SDHB. RESULTS: Hereditary syndrome was diagnosed in 30 patients (7 patients affected by MEN2A, 6 VHL, 9 NF1, 2 PGL- 1, and 6 PGL-4). 17 patients with monolateral PHEO underwent adrenalectomy (laparoscopic approach since 1998); 8 patients with bilateral adrenal lesions underwent bilateral adrenalectomy with cortical-sparing approach of almost one gland. CONCLUSIONS: Syndromic PGLs are rare conditions; surgery is the treatment of choice. Adrenal PGL requires laparoscopic adrenalectomy with transperitoneal lateral approach as gold standard. For genetic syndrome such as MEN2 and VHL, laparoscopic cortical sparing adrenalectomy of at least one gland should be considered. KEY WORDS: Adrenalectomy, Endocrine Surgery, Hereditary Syndromes, Paraganglioma, Pheochromocytoma.


Assuntos
Neoplasias das Glândulas Suprarrenais , Paraganglioma , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/cirurgia , Humanos , Paraganglioma/genética , Paraganglioma/cirurgia , Encaminhamento e Consulta , Estudos Retrospectivos , Succinato Desidrogenase , Síndrome
9.
Sci Rep ; 11(1): 18574, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535733

RESUMO

For pheochromocytoma and sympathetic paraganglioma (PPGL), surgery can be used as a curative treatment; however, the life-threatening risk of perioperative hemodynamic instability (HI) presents challenges. This study aimed to analyze the incidence and predictive factors of perioperative HI. The electronic medical records of 114 consecutive patients who underwent surgery for PPGLs at our institution were retrospectively reviewed. HI was defined as one or more episodes of systolic blood pressure > 200 mmHg or mean blood pressure < 60 mmHg during surgery. The factors predictive of perioperative HI were determined using both univariate and multivariate analyses. Intraoperative HI occurred in 79 (69.3%) patients. In multivariate analysis, α-adrenergic receptor blocker duration (days) (odds ratio, 1.015; 95% confidence interval, 1.001-1.029) was a predictor for intraoperative HI. Postoperative hypotension occurred in 36 (31.6%) patients. Higher urine epinephrine levels, and greater preoperative highest heart rate (HR) were predictive factors for postoperative hypotension in PPGL patients. Caution should be taken in perioperative management for PPGL, especially with long duration of α-adrenergic receptor blocker use, higher urine epinephrine levels, and greater preoperative highest HR.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Hemodinâmica , Paraganglioma/cirurgia , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/fisiopatologia , Período Perioperatório , Feocromocitoma/fisiopatologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
10.
Rev. colomb. anestesiol ; 49(3): e301, July-Sept. 2021. tab
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1280180

RESUMO

Abstract Pheochromocytomas are rare neuroendocrine neoplasms that require adequate preoperative evaluation in order to prevent and lessen the serious complications of catecholamine hypersecretion. Preoperative management contributes to reducing morbidity and mortality rates in patients who have not been diagnosed with this condition and undergo any surgery. However, current mortality seems to be lower, a fact attributed to preoperative management with alpha blockers.


Resumen Los feocromocitomas son neoplasias neuroendocrinas poco frecuentes que requieren una evaluación preoperatoria adecuada, con el fin de prevenir y disminuir las complicaciones graves de la hipersecreción de catecolaminas. El manejo preoperatorio contribuye a disminuir las tasas de morbimortalidad en los pacientes que no han sido diagnosticados con esta entidad y son sometidos a cualquier cirugía. Sin embargo, la mortalidad actual parece ser más baja, hecho atribuido a un manejo preoperatorio con α-bloqueadores.


Assuntos
Humanos , Masculino , Feminino , Paraganglioma , Feocromocitoma , Liberação de Cirurgia , Neoplasias , Cuidados Pós-Operatórios , Catecolaminas , Indicadores de Morbimortalidade , Morbidade , Mortalidade
11.
BMC Surg ; 21(1): 340, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496808

RESUMO

BACKGROUND: Subglottic paragangliomas (PGs) are exceptionally rare and unpredictable, occasionally presenting at an atypical location. There are three different clinical forms of subglottic PGs: intraluminal (tracheal PGs), extraluminal (thyroid PGs) and the mixed type (both intraluminal and extraluminal, mixed-subglottic PGs). These tumors are usually misdiagnosed as other relatively common primary thyroid or laryngotracheal tumors, and the treatment is troublesome. CASE PRESENTATION: A 22-year-old male patient with subglottic PGs has been successively misdiagnosed as thyroid tumors and subglottic hemangiomas, and lastly underwent local extended lumpectomy and laryngotracheal reconstruction with a pedicled thoracoacromial artery perforator flap (PTAPF). The patient was decannulated successfully after the second-stage tracheal reconstruction with a local flap, and no evidence of local recurrence and distant metastasis of the tumor until now. CONCLUSION: Subglottic PGs can be easily misdiagnosed as laryngotracheal or thyroid tumors when presented at an atypical location. It is essential for otolaryngologists and head and neck surgeons to remain vigilant against these tumors. If the tumor is not diagnosed or removed completely, patients may encounter a risk of lethal paroxysm, which is incredibly troublesome.


Assuntos
Neoplasias Laríngeas , Paraganglioma , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Glândula Tireoide , Adulto , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Masculino , Recidiva Local de Neoplasia , Paraganglioma/diagnóstico , Paraganglioma/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adulto Jovem
13.
Eur J Radiol ; 143: 109911, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34508941

RESUMO

PURPOSE: The aim of this study is to identify quantitative MR biomarkers in head and neck paragangliomas. METHODS: The study was approved by an institutional review board. A retrospective review of patients with head and neck paragangliomas (HNPGL) evaluated by time-resolved MRA sequences between 2009 and 2019 was performed. A control group investigated during the same period was analyzed, including nerve sheath tumors and metastatic lymph nodes from squamous cell carcinomas or undifferentiated nasopharyngeal cancer (UCNT). A gold standard was obtained for all cases. Semi-quantitative parameters of enhancement were extracted from time-intensity curves on time-resolved MRA sequences and diffusion weighted imaging/DWI was assessed for each lesion. RESULTS: Sixty head and neck paragangliomas (HNPGLs) were included from 50 patients. The control group consisted of 30 parapharyngeal space lesions (27 patients), which included nerve sheath tumors (n = 12) and metastatic lymph nodes (n = 18) from squamous cell carcinomas or UCNT. PGLs showed a shorter time-to-peak value compared to other groups, measured at 25.0 +/- 29 sec. The wash-in and wash-out ratios were also significantly higher for PGLs, respectively measured at 5.34 ± 2.99 (p < 0,001) and 1.24 ± 0.80 (p < 0.001). On DWI sequences, the mean ADC value for PGLs (1.17 ± 0.19 10^-3 mm2/s) was significantly different than the other tumor groups (p < 0.001). HNPGLs were clearly distinguishable from other tumors on classification with regression tree based on TTP and ADC values. These distinct group features were also consistent on principal component analysis. CONCLUSION: Our study identifies a multiparametric signature for disease subtyping, providing a strong impetus for switching from qualitative to quantitative analysis of deep soft-tissue tumors of the neck.


Assuntos
Neoplasias de Cabeça e Pescoço , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias Nasofaríngeas , Paraganglioma , Biomarcadores , Imagem de Difusão por Ressonância Magnética , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Paraganglioma/diagnóstico por imagem , Estudos Retrospectivos
15.
Clin Imaging ; 80: 292-299, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34467873

RESUMO

OBJECTIVES: To retrospectively evaluate the safety and technical success of pre-operative embolization (POE) of head and neck paragangliomas (HNP) in a single-center cohort over a 10-year period, and to benchmark our results with those derived from a systematic analysis of the available literature. METHODS: All consecutive HNP embolized between November 2010 and April 2020 were included and reviewed. In total, there were 27 HNP in 27 patients [8 (30%) males; 19 (70%) females; mean age 53 ± 16 years; range 30-86]. Embolization technique, total procedure time, dose area product (DAP), complications, rate of HNP devascularization, and technical success (i.e. ≥80% devascularization of the HNP) were recorded and analyzed. A systematic analysis on the safety and technical success of POE was then conducted according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Twenty-one (21/27; 78%) HNP were treated with an endovascular approach and 6/27 (22%) with a percutaneous or combined (endovascular/percutaneous) technique. Mean total procedure time and DAP were 108 ± 48 min (range 45-235) and 92.5 ± 61.3 Gy·cm2 (range 19.9-276.0), respectively. Two (2/27; 7%) complications (one minor, one major) were observed. Mean HNP devascularization was 88 ± 15% (range 23-100) with technical success achieved in 24/27 (89%) HNP. Literature analysis revealed a pooled rate of complication and technical success of 3.8% (95% CI: 0.5-8.8%) and 79.0% (95% CI: 63.6-91.6%), respectively. CONCLUSIONS: POE of HNP is safe and results in extensive devascularization in the majority of treated tumors.


Assuntos
Embolização Terapêutica , Neoplasias de Cabeça e Pescoço , Paraganglioma , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
16.
Clin Nucl Med ; 46(12): e565-e566, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34392278

RESUMO

ABSTRACT: We present a case of a 75-year-old woman with clinical suspicion of stroke whose cranial CT showed ischemic changes in right precentral region, without visible vascular occlusion, and a right vagal lesion suggestive of paraganglioma. Two weeks later, 68Ga-DOTATOC PET/CT with IV iodine-based contrast administration (Biograph 6 True Point equipment; Siemens) was performed for characterization of this lesion and staging. Intraparenchymal 68Ga-DOTATOC uptake was visualized in right frontal lobe suggestive of hemorrhagic transformation of the previous stroke.


Assuntos
Tumores Neuroendócrinos , Compostos Organometálicos , Paraganglioma , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Octreotida/análogos & derivados , Paraganglioma/complicações , Paraganglioma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
17.
AJNR Am J Neuroradiol ; 42(10): 1839-1846, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34446460

RESUMO

BACKGROUND AND PURPOSE: Distinguishing schwannomas from paragangliomas in the head and neck and determining succinate dehydrogenase (SDH) mutation status in paragangliomas are clinically important. We aimed to assess the clinical usefulness of DWI and dynamic contrast-enhanced MR imaging in differentiating these 2 types of tumors, as well as the SDH mutation status of paragangliomas. MATERIALS AND METHODS: This retrospective study from June 2016 to June 2020 included 42 patients with 15 schwannomas and 27 paragangliomas (10 SDH mutation-positive and 17 SDH mutation-negative). ADC values, dynamic contrast-enhanced MRI parameters, and tumor imaging characteristics were compared between the 2 tumors and between the mutation statuses of paragangliomas as appropriate. Multivariate stepwise logistic regression analysis was performed to identify significant differences in these parameters. RESULTS: Fractional plasma volume (P ≤ .001), rate transfer constant (P = .038), time-to-maximum enhancement (P < .001), maximum signal-enhancement ratio (P < .001) and maximum concentration of contrast agent (P < .001), velocity of enhancement (P = .002), and tumor characteristics including the presence of flow voids (P = .001) and enhancement patterns (P = .027) showed significant differences between schwannomas and paragangliomas, though there was no significant difference in ADC values. In the multivariate logistic regression analysis, fractional plasma volume was identified as the most significant value for differentiation of the 2 tumor types (P = .014). ADC values were significantly higher in nonhereditary than in hereditary paragangliomas, while there was no difference in dynamic contrast-enhanced MR imaging parameters. CONCLUSIONS: Dynamic contrast-enhanced MR imaging parameters show promise in differentiating head and neck schwannomas and paragangliomas, while DWI can be useful in detecting SDH mutation status in paragangliomas.


Assuntos
Neoplasias de Cabeça e Pescoço , Neurilemoma , Paraganglioma , Meios de Contraste , Imagem de Difusão por Ressonância Magnética , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Neurilemoma/diagnóstico por imagem , Neurilemoma/genética , Paraganglioma/diagnóstico por imagem , Paraganglioma/genética , Perfusão , Estudos Retrospectivos
18.
BMJ Case Rep ; 14(8)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353832

RESUMO

Pheochromocytomas (PCC) are catecholamine-secreting tumours that arise from chromaffin cells of the sympathoadrenal system. These rare catecholamine-secreting tumours arising from adrenal glands are termed as PCC and those from extra--adrenal sites are termed paraganglioma (PGL). Thoracic PGL is very rarely found. we report the anaesthetic challenges and management of an 8-year-old child with functional thoracic PGL and its successful outcome.


Assuntos
Neoplasias das Glândulas Suprarrenais , Anestésicos , Paraganglioma , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Catecolaminas , Criança , Humanos , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia
19.
Medicine (Baltimore) ; 100(34): e26909, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449457

RESUMO

RATIONALE: Bladder paraganglioma is characterized by headache, palpitations, hypertension, blurred vision, or sweating during voiding. Transurethral holmium laser resection is a safe and efficacious alternative method for the resection of bladder neoplasms. PATIENT CONCERNS: A 24-year-old female had a 2-year history of intermittent headaches, palpitation, and sweating during micturition. DIAGNOSIS: Physical examination revealed a rise in the patient's blood pressure to 180/90 mmHg after micturition. Laboratory examination found that the blood catecholamine metabolites were significantly increased. Abdominal ultrasound and computed tomography (CT) scan indicated a 37 mm × 31 mm paraganglioma situated at the right anterolateral wall of the bladder. A diagnosis of bladder paraganglioma was considered based on a comprehensive evaluation of the physical examination, laboratory examination, ultrasound and computerized tomography scan. INTERVENTIONS: Preoperative oral administration of a nonselective α-adrenergic receptor antagonist (phenoxybenzamine, 10 mg three times a day,) accompanied by a high-sodium diet and generous fluid intake, was initiated 2 weeks before the surgery to stabilize intraoperative hemodynamics. As the patient was newly married and nulligravid, management with transurethral resection was considered superior to open or partial cystectomy and was selected as the treatment method. OUTCOMES: Transurethral holmium resection of the bladder paraganglioma was successfully performed with blood loss less than 20 ml and well-controlled intraoperative blood pressure. The 1-year follow-up results demonstrated well-controlled symptoms. Cystoscopy and evaluation of blood catecholamine metabolites revealed no disease recurrence. LESSONS: Transurethral holmium laser resection is a good alternative approach for the resection of bladder paraganglioma, given its advantages of safety and efficacy.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Paraganglioma/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Feminino , Humanos , Paraganglioma/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
20.
S D Med ; 74(8): 376-379, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34461004

RESUMO

Paragangliomas are non-epithelial tumors of neuroendocrine origin that arise from the paraganglia of the sympathetic and parasympathetic nervous system. These paraganglia cells are derived from the neural crest and can be found anywhere in the body where paraganglia exist. Paragangliomas are rare tumors. It is estimated that the incidence of pheochromocytoma (intra-adrenal paraganglioma) and extra-adranal paraganglioma is 0.8 per 100,000 person years. It is commonly stated that 10 percent of paragangliomas are extra-adrenal. The majority of parasymphathetic paragangliomas reside in the skull base and along the vagus and glossopharyngeal nerves, whereas the majority of sympathetic paragangliomas can be found in the abdomen. Paragangliomas found in the mesentery are exceedingly rare, with 12 reported cases identified in the literature. We present the case of a 61-year-old female who presented to our institution with a suspected superior mesenteric artery aneurysm who was ultimately found to have an extra-adrenal paraganglioma within the small bowel mesentery of the right lower quadrant of the abdomen.


Assuntos
Neoplasias das Glândulas Suprarrenais , Paraganglioma Extrassuprarrenal , Paraganglioma , Dor Abdominal , Feminino , Humanos , Mesentério , Pessoa de Meia-Idade , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagem , Paraganglioma Extrassuprarrenal/diagnóstico , Paraganglioma Extrassuprarrenal/diagnóstico por imagem
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