Kang D, Kim BE, Hong M, Kim J, Jeong S, Lee S. Different intraoperative decisions for undiagnosed paraganglioma: Two case reports. World J Clin Cases 2022; 10(30): 11059-11065 [PMID: 36338226 DOI: 10.12998/wjcc.v10.i30.11059]
Corresponding Author of This Article
Seongheon Lee, MD, PhD, Assistant Professor, Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160 Baekseo-ro, Dong-gu, Gwangju 61469, South Korea. aneshead@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2022; 10(30): 11059-11065 Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.11059
Different intraoperative decisions for undiagnosed paraganglioma: Two case reports
Dongho Kang, Bo-eun Kim, Minjae Hong, Joungmin Kim, Seongtae Jeong, Seongheon Lee
Dongho Kang, Bo-eun Kim, Minjae Hong, Joungmin Kim, Seongtae Jeong, Seongheon Lee, Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju 61469, South Korea
Author contributions: Kang D and Kim B wrote the manuscript; Hong M and Kim J performed literature analysis; Jeong S was the anesthesiologist in charge of the patient; Lee S revised the manuscript for important intellectual content; all authors approved the final version of the manuscript to be submitted.
Informed consent statement: Informed written consents were obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seongheon Lee, MD, PhD, Assistant Professor, Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160 Baekseo-ro, Dong-gu, Gwangju 61469, South Korea. aneshead@gmail.com
Received: June 24, 2022 Peer-review started: June 24, 2022 First decision: August 7, 2022 Revised: August 20, 2022 Accepted: September 12, 2022 Article in press: September 12, 2022 Published online: October 26, 2022
Abstract
BACKGROUND
Paragangliomas may be preoperatively misdiagnosed as non-functioning retroperitoneal tumors and are sometimes suspected only at the time of intraoperative manipulation. Without preoperative alpha blockade preparation, a hypertensive crisis during tumor manipulation and hypotension after tumor removal may result in critical consequences. Therefore, primary consideration should be given to the continuation or discontinuation of surgery on the basis of the possibility of gentle surgical manipulation and hemodynamic stabilization. We report two cases of paragangliomas detected intraoperatively.
CASE SUMMARY
A 65-year-woman underwent laparoscopic small-bowel wedge resection. A hypertensive crisis occurred during manipulation of the mass, and an unrecognized catecholamine-producing paraganglioma was suspected. The surgeon and anesthesiologists believed that tumor excision could be performed with minimal manipulation of the tumor because the tumor was in a favorable location. Serious hemodynamic instability did not occur with aggressive use of vasoactive drugs. A week later, a 54-year-man underwent open resection of a 3-cm-sized retroperitoneal mass and showed the same findings during mass manipulation. For this patient, continuous manipulation of the mass seemed inevitable due to adhesion between the right adrenal gland and the mass in a narrow surgical field. The surgeon and anesthesiologists decided to cancel the surgical procedure and planned to perform a reoperation after alpha blockade therapy. Two weeks later, the tumor was uneventfully removed with small doses of vasoactive drugs.
CONCLUSION
When an undiagnosed paraganglioma is suspected intraoperatively, reoperation after adequate preparation should be considered as an option to avoid fatal outcomes.
Core Tip: Undiagnosed paragangliomas may be suspected at the time of intraoperative manipulation. Tumor removal without preoperative alpha blockade preparation can lead to serious hemodynamic instability. The present case report describes different intraoperative decisions for two patients with undiagnosed paragangliomas. Intraoperative cancellation of surgery may not always be feasible or practical, but it should be considered as an option in cases requiring frequent manipulation of the tumor.
