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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2014 March;173(3):155-60
Laparoscopic resection of a Zuckerkandl’s paraganglioma
Diez Ares J. Á., Martínez García R., Estellés N., Sospedra R., García Lozano A.
General Surgery Department Hospital Dr. Peset, Valencia, Spain
The World Health Organization (WHO) defines pheochromocytomas as “tumors arising from catecholamine-producing chromaffin cells in the adrenal medulla”. Hypertension is the most common symptom and is characterized for being hyperkinetic, hypovolemic and vasocontrictive. Imaging techniques together with 24-hour urine tests for metanephrines and plasma catecholamines are key to diagnosing and locating tumors. Complete resection surgery is the treatment of choice because it has not been shown that the use of chemotherapy and/or radiotherapy improve surgical outcome. A 53-year-old female patient was referred from our hospital’s Endocrine Department with a diagnosis of paraganglioma. The case begun with hypertensive episodes with a mean arterial pressure of 196/119 and diaphoresis, also accompanied by significant weight loss over the previous month. Hormonal parameters were also determined in 24-hour urine, highlighting normetanephrine elevation (6488 pg/24h) and Vanil mandelic acid (19.6 mg/24h). In the PET-CT we found an intense metabolic mass located in the intrapelvic area, beginning in the aorto-iliac bifurcation and extending to the hypogastrium. After the diagnosis, surgery was decided on. To this end, a preoperative process with alpha-adrenergic receptor blockade (doxazosin 4 mg/day.) was begun 8 days prior to surgery. The proceeding was initiated and completed laparoscopically. The overall hospital stay was 72 hours, with no evidence of immediate post-surgical complications and a significant decrease in blood pressure, which was at 140/90 mmHg at the time of discharge. The patient showed signs of early tolerance and transit, with little need for analgesia.