Brief Report

Posterior mediastinal paraganglioma: the experience of Kasr Alainy Thoracic Surgery Unit


Waleed Adel1, Tarek Mohsen1, Ramadan Mansou2, Ahmed Naem3, Ashraf Helal1, Ahmed Saber1,

1Department of Cardiothoracic Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
2Department of Anesthesiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
3Department of Pathology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt


Abstract


Background: Mediastinal paragangliomas are rare tumors with variable clinical presentations and combinations. Having such variable behavior and subtypes, a wide variety of tools are available that need deep study and classification to help fashion the proper tools needed for diagnosis and avoidance of complications. These complications can and will vary from intraoperative hemodynamic instability to invasion of the cardiovascular system.
Methods: During seven years, from January 2012 until November 2019, data of eight patients who underwent posterior mediastinal mass resections for paraganglioma were collected and examined. Analysis of data was retrospectively processed and categorized as follows: demographics, preoperative, operative and postoperative.
Results: Among the eight patients, three presented with symptoms suggestive of functional paraganglioma (received preoperative preparations). Another two presented with non-functional posterior mediastinal mass, while the remaining three were removed during surgery (VATS) for other morbid conditions. Of these final three, two needed conversions after hemodynamic instability. Pathology suggested ?benign pathology? with an exception for one case. The outcome of our series was excellent without morbidity or mortality.
Conclusions: Proper preoperative investigations are needed to detect functional paraganglioma to perform optimal preoperative preparation and avoid a fatal intraoperative crisis. Tissue biopsy remains questionable, the need for embolization and bypass should be considered especially in aorticopulmonary types.

Keywords: extra-adrenal paraganglioma, mediastinal neoplasms, metanephrine