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A): Chromogranin A: Tumor cells are diffusely positive for neuroendocrine marker Chromogranin A immunohistochemically. (B): H&E: Well defined nests of cuboidal cells separated by highly vascularized fibrous septa. Individual cells have a moderately abundant granular basophilic cytoplasm.
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Introduction
Paragangliomas are tumors that arise from extraadrenal chromaffin cells and most of them are asymptomatic presenting with painless mass. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Surgical resection is still the main treat...
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... after splenectomy were discussed with her. We recommended mobilization and increased fluid intake. She was started on 100 mg of aspirin daily. The patient was discharged after 7 postoperative day. One month following surgery, blood counts were in normal limits. Pathological exami- nation of the specimen was reported as paraganglioma( Fig. ...Citations
... We choose cases diagnosed with PGL located in the pancreas from 14 articles through PubMed from 2001 to 2019 ( Table 1) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). These patients' age ranged from 30 to 72 years old and only 3/15 were males. ...
... Eight patients (11,15,16,18,(20)(21)(22)(23) were presented to be abdominal discomfort and six (12,14,17,19,23,24) cases were asymptomatic. Only one special patient (13) presented with loss of appetite, weight loss, weakness, and breathlessness. CT was performed in 14 case (11,12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) and two patients (13,24) underwent MRI examinations. ...
... CT was performed in 14 case (11,12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) and two patients (13,24) underwent MRI examinations. Ultrasound was performed in 12 cases (11)(12)(13)(14)(15)(17)(18)(19)(20)(21)23) but celiac angiography was only used in one case (24). These imagined examinations help surgeons make an accurate diagnosis. ...
Paraganglioma (PGL) is an uncommon tumor located in the head, neck and abdomen. The majority of the tumor is benign and the patient has no obvious clinical symptoms. However, PGL located in the pancreas is rather rare and tends to mimic Castleman's disease, pancreatic neuroendocrine tumors and pancreatic primary tumor. Herein, we reported a patient with PGL that occurred in the neck of the pancreas. A 75-year-old Chinese female presented to our hospital with a complaint of upper abdomen pain for two weeks and she had good past health. The laboratory findings and physical examination were all normal. Preoperative computed tomography (CT) and magnetic resonance imaging revealed a tumor located in the neck of the pancreas and a tentative diagnosis of Castleman's disease or PGL was made. We resected the tumor by laparoscopic surgery. Postoperative pathology and immunohistochemistry confirmed that the tumor was a PGL. The patient was recovered well after a postoperative follow-up of 6 months. PGL located in the neck of the pancreas is difficult to be diagnosed accurately and clinicians have difficulties in distinguishing PGL from Castleman's disease, pancreatic neuroendocrine tumors and pancreatic primary tumor. Fifteen cases were listed to show the characters of PGL located in the pancreas and we also presented the difference among PGL, Castleman's disease and pancreatic neuroendocrine tumor. We showed our experience of treating such a rare tumor hoping to help clinicians correctly diagnose and treat PGL.
Primary pancreatic paragangliomas are rare. They are mainly non-functional tumours that lack typical clinical manifestations. Definite diagnosis relies on histopathology and immunohistochemistry, and the main treatment is surgery. We report here a case of primary, non-functional, pancreatic paraganglioma in a 49-year-old woman. The tumour was approximately 5.0 × 3.2 ×4.7 cm in size and located in the pancreatic neck and body. We undertook 3D laparoscopic complete resection of the tumour. The patient developed a pancreatic fistula (biochemical leak) post-surgery, but she recovered and was discharged from hospital 11 days after surgery. We describe this case study and briefly summarize previous related reports.
Extra-adrenal functional neuroendocrine neoplasms are termed paragangliomas. We describe a case of a large abdominal neuroendocrine tumor that was proved to be a paraganglioma on biopsy. Unfortunately, the patient presented with high output heart failure, an extremely rare complication of paraganglioma. Prior to surgical biopsy, the patient underwent a complete invasive and non-invasive cardiac workup, in addition to biochemical testing. On a PET CT, the retroperitoneal neuroendocrine tumor was shown to have been metastasized to the spine. Chemotherapy targeted at somatostatin analogs was initiated. The unique presentation and rare complications are presented with relevant review of literature to highlight the spectrum of disease geared towards diagnostic and interventional radiologists. It is crucial to understand the broad spectrum of disease and include this entity in the differential diagnosis of a retroperitoneal mass. Equally significant is to consider potential complications such as metastases and cardiac failure to guide appropriate workup and management.
The purpose of this study was to investigate, first, the effect on enhancement of the liver and aorta during abdominal CT of the use of saline solution as a partial substitute for or in addition to contrast medium when the dose of medium is determined by the patient's body weight and, second, whether use of a saline chaser allows a decrease in the dose of contrast medium to less than 1.5 mL/kg.
We enrolled 407 patients undergoing abdominal exploration on MDCT, including an early arterial phase and a portal phase. Group 1 received contrast medium at a dose of 1.5 mL/kg. Group 2 received contrast medium at a dose of 1.5 mL/kg less 20 mL of iodine followed by 30 mL of saline solution. Group 3 received the full 1.5 mL/kg dose of medium followed by a 30-mL saline chaser. Attenuation values were obtained from the aorta in the arterial phase and from the liver in the portal phase.
The groups were comparable in mean body weight and heart rate. None of the differences between them in aortic enhancement in the early arterial phase were statistically significant (group 1, 206 +/- 3 H; group 2, 204 +/- 3 H; group 3, 209 +/- 4 H). There was a negative correlation between weight and aortic enhancement (r = -0.42, p < 0.0001) and a positive correlation between weight and hepatic enhancement (r = 0.19, p < 0.0001). A significant reduction (p = 0.0002) in hepatic enhancement was observed in group 2 (group 1, 53 H; group 2, 46 H; group 3, 54 H). Hepatic enhancement greater than 45 H was observed in all groups except for the group 2 subgroup of patients weighing less than 55 kg.
In MDCT, reducing the amount of contrast medium does not affect aortic enhancement in the early arterial phase but decreases hepatic enhancement at the portal phase. The saline chaser technique had no influence on the phases studied. Greater than 1.5 mL/kg reduction in the dose of contrast medium followed by saline flushing may not be advisable for liver CT in low- and medium-weight patients.
