Metastatic Paraganglioma
HISTORY OF PRESENT ILLNESS:
This is a 44-year-old previously incarcerated African-American male
with a large soft-tissue mass in his right buttock with widespread
metastasis, multiple osteolytic lesions, complete erosion of his
right ischium and retroperitoneal tumor recently found to be a
paraganglioma. He has received multiple radiation treatments for his
cancer which has until now remained undiagnosed. He was previously
treated for metastatic renal cell carcinoma. His last admission was
due to worsening of shortness of breath and pain. At that time, he
had pneumonia.
SOCIAL HISTORY:
He was incarcerated in prison and served 6 years of time until
present. He had 18 years of his sentence suspended following his
diagnosis.
FAMILY HISTORY:
Mother with stomach cancer. Mother deceased at age 55. Father alive
and well at age 68. Maternal grandmother with a cancer that the
patient is unsure of. Patient has 22 brothers and sisters with an
array of medical problems, cancers, diabetes and heart disease.
Radiology Report: OCTREOSCAN
CLINICAL INDICATION: Paraganglioma.
PROCEDURE: Spot images were obtained from the head down through the
knees and SPECT CT scanning of the abdomen and pelvis was performed
per protocol following intravenous administration of 9.3mCi
indium-111 Octreoscan.
FINDINGS: There are multiple foci of increased activity throughout
the body. These include the skull, axillary lymph nodes,
supraclavicular lymph nodes, mediastinal lymph nodes, abdominal and
retroperitoneal lymph nodes, iliac nodes and in the soft tissues of
the femur. SPECT imaging localized many of the foci to the bones
matching the patient's recent CT scan. There also appear to be
nodules superficially either in the peritoneum or the abdominal
wall. There are no foci seen within the liver or spleen.
IMPRESSION:
1. WIDESPREAD METASTATIC DISEASE FROM MALIGNANT PARAGANGLIOMA.
HOSPITAL COURSE:
The patient was admitted to the hospital. He received etoposide and
cisplatin, and he received allopurinol plus IV hydration. He also
was continued on his pain medications. Serum catecholamine levels
were drawn since this was a paraganglioma tumor
Teaching Note:
Pheochromocytomas are tumors that arise from the
adrenal medulla whereas paragangliomas arise from extra-adrenal
sympathetic ganglia. These tumors can secrete excessive amounts of
norepinephrine and epinephrine, causing a dangerous exaggeration of
the stress response. The patient should be questioned as to symptoms
of sympathetic discharge that may represent a functionally secreting
tumor, such as tachycardia, arrhythmias, flushing, or labile
hypertension.
