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Park, Park, Bang, Kim, Jeon, Koh, Suh, Chung, Kim, Kwon, Go, and Um: A Case of Middle Mediastinal Malignant Paraganglioma
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(2): 165-169.

Published online: 28 February 2011

DOI: https://doi.org/10.4046/trd.2011.70.2.165

A Case of Middle Mediastinal Malignant Paraganglioma

Sung Bum Park, M.D.1, Silvia Park, M.D.1, Sun Ha Bang, M.D.1, Eun Kyung Kim, M.D.1, Kyeongman Jeon, M.D.1, 2, Won-Jung Koh, M.D.1, 2, Gee Young Suh, M.D.1, 2, Man Pyo Chung, M.D.1, 2, Hojoong Kim, M.D.1, 2, O Jung Kwon, M.D.1, 2, Young-Hyeh Go, M.D.3, Sang-Won Um, M.D.1, 2

1Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

3Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address for correspondence: Sang-Won Um, M.D., PhD. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Kangnamgu, Seoul 135-710, Korea. Phone: 82-2-3410-3429, Fax: 82-2-3410-3849, sangwonum@skku.edu

Received 17 September 2010       Accepted 13 October 2010

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Pheochromocytomas are neuroendocrine tumors of chromaffin cell that originate in the paraganglia of the adrenal medulla. Approximately 10% of pheochromocytomas are found in the extra-adrenal paraganglia and are called paragangliomas. However, cases of middle mediastinal paragangliomas are very rare. In this case, the patient presented with a voice change and a headache. A middle mediastinal soft tissue mass with marked enhancement was detected on computed tomography of the chest. The 24-hour urine catecholamine level was markedly elevated. The middle mediastinal mass was biopsied via mediastinoscopy and the resulting immunohistochemical staining was compatible with a diagnosis of middle mediastinal paraganglioma. The mass was resected surgically and the symptoms were relieved.

Keywords: Paraganglioma, Mediastinum, Neoplasms

Figures and Tables

Figure 1
(A) The patient's chest CT scan results. A 34-mm highly enhancing but somewhat heterogeneous soft tissue mass is present in the lower left paratracheal area and in the aorto-pulmonary window of the middle mediastinum on the chest CT scan. (B) The patient's PET/CT scan results. A soft tissue mass with FDG uptake is present in the lower left paratracheal area of the middle mediastinum on the PET/CT scan. (C) The patient's bronchoscopy findings. The mucosa of the carina, left main bronchus, and left side of the lower trachea shows features consistent with hypervascularity on bronchoscopy. CT: computed tomography; PET: positron emission tomography.
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Figure 2
(A) The result of IHC staining for cytokeratin is negative (×40). (B) The results of IHC staining for synaptophysin (positive) (×200). (C) The results of IHC staining for chromogranin A (positive) (×100). All results are highly suggestive of paraganglioma.
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