Malignant retroperitoneal paraganglioma treated with radiotherapy: A case report

Abstract

Paragangliomas are rare tumors arising from undifferentiated cells of the primitive neural crest. We report a case of a 33-year-old female patient who presented a large firm retroperitoneal tumor situated on the left flank above the left kidney. Levels of the serum epinephrine and norepinephrine were high. We performed a scanned biopsy; the histopathological examination and the immunohistochemical analyses concluded the diagnosis of a retroperitoneal paraganglioma. The tumor was judged secreting and inoperable; therefore it was decided to be treated with radiotherapy.

Keywords

• Retroperitoneal paraganglioma,Radiotherapy,Secretory tumor,Pheochromocytoma

Radyoterapi ile tedavi edilen malign retroperitoneal paraganglioma: Olgu sunumu

Öz

Paragangliomalar, ilkel nöral krest'in farklılaşmamış hücrelerinden kaynaklanan nadir tümörlerdir. Sol böbreğin sol böbrek üzerinde yer alan geniş retroperitonal tümör hastası olan 33 yaşında bir kadın hastayı sunduk. Serum epinefrin ve norepinefrin düzeyleri yüksek bulundu. Taranmış bir biyopsi yaptık; Histopatolojik inceleme ve immunohistokimyasal analizler retroperitoneal paraganglioma tanısını koydu. Tümör salgılanıp inoperabl olarak değerlendirildi; Bu nedenle radyoterapi ile tedavi edilmeye karar verildi.

Anahtar Kelimeler

• Retroperitoneal paraganglioma,Radyoterapi,Secretory tumor,Pheochromocytoma

References

1. 1. Lack EE, Cubilla AL, Woodruff JM, Lieberman PH. Extra-adrenal paragangliomas of the retroperitoneum. A clinicopathological study of 12 tumors. Am J Surg Pathol. 1980;4:109–20.
2. 2. Sclafani LM, Woodruff JM, Brennan MF. Extraadrenal retroperitoneal paragangliomas: natural history and response to treatment. Surgery. 1990;108:1124–9.
3. 3. Razakaboay M, Maillefert JF, Wendling D, et al. Bone metastases from a paraganglioma. A review of five cases. Rev Rheum Engl Ed. 1999;66:86–91.
4. 4. Karaçetin D, Halefoğlu A, Kabukçuoğlu F, Tatar Z. Retroperitoneal Paraganglioma: Case Presentation. Istanbul Med J. 2010;11(3):137-41.
5. 5. Rajiah P, Sinha R, Cuevas C, et al. Imaging of Uncommon Retroperitoneal Masses, Gastrointestinal Imaging; RadioGraphics. 2011;31:949–76.
6. 6. Nishino M, Hayakawa K, Minami M, Yamamoto A, Ueda H, Takasu K. Primary retroperitoneal neoplasms: CT and MRI imaging findings with anatomic and pathologic diagnostic clues. Radiographics. 2003;23(1):45–57.
7. 7. Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 2003;23(1):29–43.
8. 8. Yang JH, Bae SJ, Park S, et al. Bilateral pheochromocytoma associated with paraganglioma and papillary thyroid carcinoma: report of an unusual case. Endocrine Journal. 2007;54(2):227–31.

9. 9. Kaltsas GA, Besser GM, Grossman AB. The diagnosis and medical management of advanced neuroendocrine tumors. Endocrine Reviews. 2004;25(3):458–511.
10. 10. Rouaix-Emery N, Tierny-Fontalirand C, Cardot-Bauters C, Carnaille B, Wemeau J, d’Herbomez M. Le diagnostic biologique de phéochromocytome En. Ann Biol Clin. 2014;72(1) :7-13.
11. 11. Kaltsas GA, Besser GM, Grossman AB. The diagnosis and medical management of advanced neuroendocrine tumors. Endocrine Reviews. 2004;25(3):458–511.
12. 12. Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 2003;23(1):29–43.
13. 13. Tonyukuk V, Emral R, Temiskan S, et al. “Patient with multiple paraganglioma treated with long acting somatostatin analogue,” Endocrine Journal, vol. 50, no. 5, pp. 507–513, 2003.
14. 14. Somasundar P, Krouse R, Hostetter R, et al. Paragangliomas—a decade of clinical experience. Journal of Surgical Oncology. 2000;74(4):286–90.
15. 15. Bryant RL, Stevenson DR, Hunton DW, et al. Primary malignant retroperitoneal tumors. Current management. Am J Surg. 1982;144:646-9.
16. 16. Mikhail RA, Moore JB, Reed DN Jr, et al. Malignant retroperitoneal paragangliomas. J Surg Oncol. 1986;32:32-6.
17. 17. Sclafani LM, Woodruff JM, Brennan MF. Extraadrenal retroperitoneal paragangliomas: natural history and response to treatment. Surgery. 1990;108:1124-9.
18. 18. Gannana E, van Veenendaal P, Scarlett A, Ng M. Retroperitoneal non-functioning paraganglioma: A difficult tumour to diagnose and treat. International Journal of Surgery Case Reports. 2015;17:133–5.
19. 19. Krych AJ, Foote RL, Brown PD, Garces Y, Link MJ. Long-term results of irradiation for paraganglioma. Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1063-6.