Pulmonary and mediastinal paragangliomas: rare endothoracic malignancies with challenging diagnosis and treatment
| Autor: | Angela Fiorella, Francesco Di Gennaro, Ondina Pizzuto, Gaetano Lastilla, Marcella Schiavone, Michele Loizzi, Antonia Gentile, G. Garofalo, Rosatea Quercia, Mariagrazia Lorusso, Leonardo Resta, E. Maiolino, Giulia De Iaco, Angela De Palma, Giulia Nex |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Lung medicine.diagnostic_test business.industry Mediastinum Magnetic resonance imaging 030204 cardiovascular system & hematology Malignancy medicine.disease Asymptomatic 03 medical and health sciences Dissection 0302 clinical medicine medicine.anatomical_structure Paraganglioma 030220 oncology & carcinogenesis medicine Original Article Radiology medicine.symptom business Wedge resection (lung) |
| Zdroj: | Journal of Thoracic Disease. 10:5318-5327 |
| ISSN: | 2077-6624 2072-1439 |
| DOI: | 10.21037/jtd.2018.09.01 |
| Popis: | Background: Pulmonary and mediastinal paragangliomas are rare tumors that may have neuroendocrine activity or be non-functional, incidental, in asymptomatic patients, or causing mass effect symptoms. Although being low-grade tumors, they can display an aggressive behaviour, developing local infiltration and distant metastases. We report our experience with three endothoracic paragangliomas and a Literature review, to point out diagnostic difficulties and problems related to surgical treatment. Methods: From 2009 to 2017, we treated 3 patients with histological diagnosis of paraganglioma: 2 pulmonary, 1 mediastinal. No one presented catecholamine-secreting syndromes; pulmonary cases were asymptomatic, while the mediastinal one had aspecific cough and dyspnea. Imaging diagnosis was based on chest computerized tomography (CT) and magnetic resonance imaging (MRI) scan. No patient had preoperative histological diagnosis. Intraoperative pathological examination was suggestive for malignancy: in pulmonary cases, wedge resection and lobectomy were performed; the middle mediastinal mass was completely removed after challenging dissection, isolation and section of numerous vascular pedicles. Results: Postoperative course was uneventful in all cases. No patient received adjuvant treatments. At a median follow-up of 47 months (range, 6–102 months), two patients are alive, without local or distant recurrence; one patient died 6 months after surgery, due to disease progression. Conclusions: Endothoracic paragangliomas, rare and often asymptomatic tumors, are of difficult diagnosis and should be considered malignant tumors, due to the potential aggressive behaviour of cases with high mitotic index and the frequent possibility of recurrence and metastases. Surgical resection is the treatment of choice and careful intraoperative manipulation is recommended, due to the high vascularity of these tumors, to prevent complications. After complete excision, long-term prognosis is generally good. However, even after surgical removal, a close, periodical and life-long follow-up is mandatory. |
| Databáze: | OpenAIRE |
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