Original article
General thoracic
Mediastinal Paragangliomas: The Mayo Clinic Experience

https://doi.org/10.1016/j.athoracsur.2008.04.105Get rights and content

Background

Extra-adrenal catecholamine-secreting tumors are referred to as paragangliomas. We reviewed our experience with mediastinal paragangliomas treated at Mayo Clinic over the last 30 years.

Methods

Fourteen patients were identified who had resection of a mediastinal paraganglioma between 1973 and 2007. Perioperative data obtained from the medical record and follow-up information were reviewed.

Results

The median age of patients at operation was 39 years (range, 27 to 68 years), 71% were female, and all had a history of hypertension. Preoperative diagnosis of a catecholamine-secreting tumor was confirmed through elevated 24-hour urinary norepinephrine in 12 patients and tumor location was determined with metaiodobenzylguanidine scintigraphy, computed tomography or magnetic resonance imaging scans in the majority. The tumor was adjacent to the heart or great vessels in all patients and was resected through a median sternotomy (n = 10), or with posterolateral thoracotomy (n = 4). In 6 patients, cardiopulmonary bypass was used to facilitate dissection of the paraganglioma from the heart or great vessels. There was one intraoperative death in this series due to blood loss. Ten of the 11 patients were alive at follow-up (median follow-up: 2.3 years; range, 0 to 19.4 years). Symptoms of catecholamine excess were eliminated or greatly improved in all patients who had a functioning tumor preoperatively, but 6 of these patients were still being treated with antihypertensive medications.

Conclusions

Functional paragangliomas can be diagnosed with measurement of fractionated catecholamines and metanephrines; mediastinal localization is determined with appropriate scanning techniques. These tumors can be treated successfully by surgical resection with modest surgical risk, often necessitating cardiopulmonary bypass, with good long-term survival. Hypertension may persist even after complete resection of the tumor.

Section snippets

Material and Methods

After approval from the Mayo Clinic Institutional Review Board, we identified 14 patients who underwent resection of a mediastinal paraganglioma at our Clinic from 1973 through 2007. Perioperative data were collected using all available medical records from the time of diagnosis to the present time. Follow-up included use of all medical records and a database that included late clinical outcomes obtained through prospective surveys. Survival was ascertained through Accurint (Philadelphia, PA; //www.accurint.com

Results

The median age of these patients was 39 years (range, 27 to 68 years) and 71% were female. All patients had a history of hypertension with varying degrees of control with standard medications. The median preoperative blood pressure was 126/76 mm Hg (range, 95/61 to 175/85 mm Hg). Prior to surgical exploration, patients were prepared with a combination of alpha-adrenergic blockade (n = 12), beta-adrenergic blockade (n = 9), and tyrosine hydroxylase inhibition (n = 7) (Table 1). One patient had a

Comment

Mediastinal paragangliomas are rare tumors and therefore it is not surprising that most publications detailing treatment of mediastinal paragangliomas are single case reports [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. However, physicians at the University of Michigan reported 12 intrapericardial paragangliomas in 1996 [6]. Herein we report the Mayo Clinic experience of 14 patients who had surgical resection of these tumors between 1973 and 2007.

The mediastinal paragangliomas in our study

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