Retro-peritoneal paraganglioma, diagnosis and management

• Published in: Progrès en urologie (Paris) Vol. 28; no. 10; p. 488
• Main Authors: Karray, O, Saadi, A, Chakroun, M, Ayed, H, Cherif, M, Bouzouita, A, Slama, M R B, Derouiche, A, Chebil, M
• Format: Journal Article
• Language: English
• Published: France 01-09-2018
• Subjects: Adult; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neoplasm Recurrence, Local; Paraganglioma - diagnosis; Paraganglioma - pathology; Paraganglioma - surgery; Pheochromocytoma - diagnosis; Pheochromocytoma - pathology; Retroperitoneal Neoplasms - diagnosis; Retroperitoneal Neoplasms - pathology; Retroperitoneal Neoplasms - surgery; Tomography, X-Ray Computed - methods; Paragangliomes; Surgery; Chirurgie; Paraganglioma; Retroperitoneal neoplasms; Anesthesia; Tumeurs retro-péritonéales; Anesthésie
• ISSN: 1166-7087
• DOI: 10.1016/j.purol.2018.06.003

Paragangliomas, defined as extra-adrenal chromaffin-cells tumors, are rarely located in the retro-peritoneum. Clinical presentation is similar to pheochromocytoma, and mainly depends on the producing character of the tumor. Positive diagnosis requires plasmatic and urinary hormonal assays. Radiological and isotopic explorations are essential before surgery. The only curative therapeutic strategy is surgical, associated to peri-operative prevention and monitoring of the frequently reported hemodynamic and cardiovascular disorders. Outcome depends of the metastatic character of the tumor, the presence of tumor remnant after surgical resection. Genetic study is recommended; the risk of recurrence and association to other neoplasm is more described in genetic forms.
Authors report 5cases of retro-peritoneal paraganglioma, operated in the department of urology of Hospital, between 2013 and 2017. Observations are about 2men and 3women. Clinical presentation is not always specific and paraganglioma may be discovered fortuitously. Two patients have been operated by coelioscopic approach, midline incision was performed in two other cases, and dorsal lumbotomy associated to a Rutherford-Morrison incision in a patient.
Two patients presented resistant hypertension and palpitation associated to suspect retro-peritoneal masses in imagery and elevated urinary methoxylated derivates before surgery. One patient was asymptomatic and the tumor was discovered in imagery. Per-operative hypertensive crisis and sinus tachycardia occurred in a case. The average follow-up period is 22.8months. Hypertension and palpitation disappeared after surgery. There was no recurrence for all the operated patients.
Retro-peritoneal paraganglioma is a rare condition. Symptoms are not specific and clinical presentation may be similar to pheochromocytoma. Abdominal CT-scan and MRI, in association with MIBG scintigraphy are strongly evocative. Histological examination ensures diagnosis. Per-operative cardio-vascular disorders are to consider and must prevented and managed by anesthesiologists. Complete surgical resection is the only curative treatment and avoids recurrences.