Laparoscopic resection of a large clinically silent paraganglioma at the organ of Zuckerkandl: a rare case report and re
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CASE REPORT
Laparoscopic resection of a large clinically silent paraganglioma at the organ of Zuckerkandl: a rare case report and review of the literature Xiang Ren1, Jiwen Shang1,2* , Ruimin Ren2, Huajun Zhang2 and Xue Yao2
Abstract Background: Large paraganglioma of the Zuckerkandl organ (POZ) is extremely rare. The patient can occasionally be paucisymptomatic, further obscuring the diagnosis and carrying high mortality. Recommended treatment for large paraganglioma (PGL) is open surgical removal. We report a case of successful laparoscopic resection of a large POZ with normal blood pressure in a 45-year-old man. Case presentation: A 45-year-old man was hospitalized because of hyperglycemia. Computed tomography of the abdomen and the serum and urinary catecholamine levels confirmed the diagnosis of large POZ. But his blood pressure was normal and he underwent laparoscopic tumor excision successfully. During 6 months follow-up after laparoscopy, serum and urinary catecholamines were normal but glycaemia remained high level. DNA analysis of the succinate dehydrogenase complex subunits B (SDHB) and SDHD revealed no mutation. Conclusions: POZ is an unusual mass and preoperative diagnosis can be difficult in clinically silent cases. PGL cannot be excluded in patients with normal blood pressure. Even a large POZ can be excised laparoscopically by following proper techniques. Keywords: Paraganglioma, Large, Silent, Organ of zuckerkandl, Laparoscopy, Genetic testing Background PGLs are catecholamine-producing tumors that may occur anywhere along the sympathetic paraganglionic chain [1]. The treatment of PGL including its diagnosis is difficult, especially when some patients lack typical clinical signs and symptoms (headache, palpitations, sweating, or hypertension) which are due to the direct actions of secreted catecholamines. About 53% of PGLs occur in the organs of Zuckerkandl [2], which are a collection of paraganglia located anterolaterally to the distal abdominal aorta between the origin of the inferior mesenteric *Correspondence: [email protected] 1 Graduate School, Shanxi Medical University, Taiyuan 030000, China Full list of author information is available at the end of the article
artery or renal artery and the aortic bifurcation. The majority of POZs are non-functional [3], so misdiagnosis and missed diagnosis are common. Traditional treatment for large POZ was open surgical resection, and only a few cases of laparoscopic approach to this pathology have been reported (Table 1). We report a case of successful laparoscopic resection of a large POZ with normal blood pressure in a 45-year-old man and review the related literature on POZ.
Case presentation A 45-year-old man with a half-year history of hyperglycemia presented to endocrinology. The patient denied attacks of headache, hypertension, palpitation and sweating. He was kept for observation with 24-h
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits us
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