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Paraganglioma presenting as metastatic lesion in a cervical vertebra: a case report and review of the literature.
Spine (Phila Pa 1976). 2010 Mar 01; 35(5):E152-4.S

Abstract

STUDY DESIGN

Case report.

OBJECTIVE

To discuss the spinal presentation and treatment of paraganglioma, a rare tumor of the extra-adrenal paraganglia, derived from neural crest cells in sympathetic ganglions.

SUMMARY OF BACKGROUND DATA

Malignant paragangliomas are a very rare entity. The diagnosis of malignant paraganglioma is made by local recurrence after total resection of the primary mass, or findings of distant metastases. Roughly half of distant metastases are located in the cervical lymph nodes, and the remainder is evenly distributed among bone, lung, and liver. Vertebral metastases are exceedingly rare, and only isolated case reports have described them.

METHODS

A 71-year-old man reported increasing neck pain and upper extremity weakness. The patient had a previous carotid body tumor resection in the past and a contralateral carotid body tumor left intact. Our imaging workup, including plain radiograph, computerized tomography scan and MRI, revealed an intraosseous lesion at C6 with vertebral body destruction. The patient underwent decompressive surgery through an anterior Smith-Robinson approach for myelopathy, followed by adjuvant external beam radiation. The histologic and immunohistochemical assays revealed a malignant paraganglioma.

RESULTS

Paragangliomas are often highly vascular tumors. Intraoperative blood loss was significant and may have been mitigated by preoperative embolization. The patient showed clinical improvement almost immediately after surgery.

CONCLUSION

We report a rare case of malignant paraganglioma and discussed adjuvant treatments to consider for distant metastases, such as I-MIBG, conventional radiotherapy, and chemotherapy.

Authors+Show Affiliations

Department of Orthopaedic Surgery and daggerPathology, University of Missouri, Columbia, MO 65212, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

20118832

Citation

Lehmen, Jeff A., et al. "Paraganglioma Presenting as Metastatic Lesion in a Cervical Vertebra: a Case Report and Review of the Literature." Spine, vol. 35, no. 5, 2010, pp. E152-4.
Lehmen JA, Babbel DM, Mikhitarian K, et al. Paraganglioma presenting as metastatic lesion in a cervical vertebra: a case report and review of the literature. Spine. 2010;35(5):E152-4.
Lehmen, J. A., Babbel, D. M., Mikhitarian, K., & Choma, T. J. (2010). Paraganglioma presenting as metastatic lesion in a cervical vertebra: a case report and review of the literature. Spine, 35(5), E152-4. https://doi.org/10.1097/BRS.0b013e3181cf2c96
Lehmen JA, et al. Paraganglioma Presenting as Metastatic Lesion in a Cervical Vertebra: a Case Report and Review of the Literature. Spine. 2010 Mar 1;35(5):E152-4. PubMed PMID: 20118832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paraganglioma presenting as metastatic lesion in a cervical vertebra: a case report and review of the literature. AU - Lehmen,Jeff A, AU - Babbel,Daniel M, AU - Mikhitarian,Kaidi, AU - Choma,Theodore J, PY - 2010/2/2/entrez PY - 2010/2/2/pubmed PY - 2010/5/26/medline SP - E152 EP - 4 JF - Spine JO - Spine VL - 35 IS - 5 N2 - STUDY DESIGN: Case report. OBJECTIVE: To discuss the spinal presentation and treatment of paraganglioma, a rare tumor of the extra-adrenal paraganglia, derived from neural crest cells in sympathetic ganglions. SUMMARY OF BACKGROUND DATA: Malignant paragangliomas are a very rare entity. The diagnosis of malignant paraganglioma is made by local recurrence after total resection of the primary mass, or findings of distant metastases. Roughly half of distant metastases are located in the cervical lymph nodes, and the remainder is evenly distributed among bone, lung, and liver. Vertebral metastases are exceedingly rare, and only isolated case reports have described them. METHODS: A 71-year-old man reported increasing neck pain and upper extremity weakness. The patient had a previous carotid body tumor resection in the past and a contralateral carotid body tumor left intact. Our imaging workup, including plain radiograph, computerized tomography scan and MRI, revealed an intraosseous lesion at C6 with vertebral body destruction. The patient underwent decompressive surgery through an anterior Smith-Robinson approach for myelopathy, followed by adjuvant external beam radiation. The histologic and immunohistochemical assays revealed a malignant paraganglioma. RESULTS: Paragangliomas are often highly vascular tumors. Intraoperative blood loss was significant and may have been mitigated by preoperative embolization. The patient showed clinical improvement almost immediately after surgery. CONCLUSION: We report a rare case of malignant paraganglioma and discussed adjuvant treatments to consider for distant metastases, such as I-MIBG, conventional radiotherapy, and chemotherapy. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/20118832/Paraganglioma_presenting_as_metastatic_lesion_in_a_cervical_vertebra:_a_case_report_and_review_of_the_literature_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3181cf2c96 DB - PRIME DP - Unbound Medicine ER -