, Volume 54, Issue 8, pp 1621-1624
Date: 30 Apr 2009

Massive Extra-adrenal Retroperitoneal Paraganglioma: Pre-operative Embolization and Resection

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Case Presentation and Evolution

A 57-year-old male presented with left-sided abdominal pain. A thorough history revealed only frequent headaches worsening over the past 5 years and the recent onset of tremor. Physical examination and laboratory values where unremarkable. A computed tomography (CT) scan of the abdomen showed an 11 × 7 × 9.6 cm heterogeneous, markedly hypervascular mass located in the left para-aortic retroperitoneum and exhibiting massively enlarged tumor vessels measuring up to 18 mm (Fig. 1a–c). Although there was a tissue plane separating the mass from the pancreas and left kidney, hydronephrosis was noted and subsequently resolved after placement of a ureteral stent. Plasma-free metanephrines were elevated at 385 pg/ml (normal, <205 pg/ml), and plasma-free normetanephrines were 339 pg/ml (normal, <148 pg/ml). Phenoxybenzamine, 10 mg twice daily, was initiated and continued for 4 weeks prior to surgery. Aiming to minimize blood loss and facilitate resection, preoperat