A SURGICAL CASE OF RETROPERITONEAL PARAGANGLIOMA CAUSING INTRAOPERATIVE HYPERTENSION

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  • TAKAGAWA Ryo
    Gastroenterological Center, Yokohama City University Medical Center
  • OSHIMA Tsukasa
    Gastroenterological Center, Yokohama City University Medical Center
  • HATORI Shinsuke
    Gastroenterological Center, Yokohama City University Medical Center
  • KUNISAKI Chikara
    Gastroenterological Center, Yokohama City University Medical Center
  • IKE Hideyuki
    Gastroenterological Center, Yokohama City University Medical Center
  • IMADA Toshio
    Gastroenterological Center, Yokohama City University Medical Center
  • KAMIJO Seiko
    Department of Pathology, Yokohama City University Medical Center

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  • 術中高血圧をきたした後腹膜パラガングリオーマの１例

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Abstract

A 45-year-old man was seen at the hospital because of a retroperitoneal tumor detected by abdominal ultrasonography at a clinical survey. On blood biochemical tests, elevated blood levels of noradrenalin and dopamine were noted. Abdominal CT scan revealed a tumor about 4 cm in diameter located on the left side of the aorta which appeared to be adjacent to the inferior margin of the pancreas, suggesting a tumor arisen from the pancreas. However, enhanced magnetic resonance imaging scan demonstrated the border with the pancreas, and a possibility of a pancreatic tumor was ruled out. Angiography showed accumulation of contrast material in the 12th intercostal and the first lumber arteries. From these findings we thought that neurogenic tumor was most likely and performed surgery. During surgery, prominent elevation in blood pressure occurred. So we suspended the operation, dealt with hypertension with a depressor, and successfully removed the tumor. The removed tumor was 3.8 cm in diameter and spherical in shape and had a fibrous capsule, of which section was cystic with a solid part. Histopathologically tumor cells proliferated in honeycomb pattern, and characteristic sustentacular cells which were chromoglanine A and S-100 positive were identified. Accordingly paraganglioma was diagnosed. As for differential diagnosis between benign or malignant lesion, the tumor was dignosed as benign because Ki-67-positive cells were less than 10%.<br>This case of retroperitoneal paraganglioma which is a relatively rare entity is presented, together with some bibliographical comments.

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