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Diagnosis and Management of Paraganglioma: An Analysis of 106 Cases

Author: XuWeiFeng
Tutor: LiHanZhong
School: Peking Union Medical College , China
Course: Department of Urology
Keywords: Paraganglioma Laparoscopic Malignant
CLC: R730.5
Type: Master's thesis
Year: 2008
Downloads: 114
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Abstract


Objective To improve the diagnosis and treatment of paraganglioma. Materials and Methods Union Medical College Hospital from 1986 to 2007, 106 patients were treated paraganglioma cases were analyzed retrospectively. Male 51 cases, female 55 cases. Age of onset is 13-73 years, mean 38.8 ± 14.16 years. Tumor: 87 cases of retroperitoneal bladder seven cases, mediastinum, the seven cases, four cases of cardiac, liver. Single tumor 85 cases, 21 cases of multiple tumors. Tumor diameter of 1.5-22cm, an average of 6.55 ± 3.22cm. 82 cases of treatment of hypertension and related symptoms, physical examination, or other symptoms of treatment 24 cases. 92 cases underwent 24-hour urinary catecholamine check: the elevated norepinephrine 78 cases (85%), epinephrine increased in 57 cases (61%). 3 times higher than normal catecholamine levels that mainly to the secretion of the hormone, 72 patients (78%) patients with norepinephrine secretion. MIBG check the 46 cases were positive in 37 cases (80.5%). Line octreotide check the 32 cases were positive in 26 cases (81%). MIBG negative 9 routine the octreotide checks, 7 cases were positive. 96 routine enhanced CT examination, in addition to two cases of cardiac tumors, lesions were found. MRI of 49 patients, lesions were found. The results of surgical treatment of 99 patients, 7 patients without surgery. Operation group to remove the tumor, 84 cases of open surgery, 15 cases of laparoscopic surgery. Cardiac paraganglioma four cases are completed in cardiopulmonary bypass conditions, patients need coronary artery bypass surgery. The open surgery time 70-380min, the average 115min bleeding 200-2400ml, an average of 362 ± 133 ml of. 18 patients required blood transfusion, blood transfusion 400 ~ 1800ml, average 600ml. Laparoscopic surgery time 50-230min, an average of 92 ± 37min. Bleeding 50-320ml, 103 ± 61ml, no blood transfusion. Three cases of postoperative complications of pneumonia, deep vein thrombosis in 1 case, and 1 died. Pathological are paraganglioma. Vicious 34 cases: 17 cases of capsular invasion, two cases of intravascular visible tumor thrombus, nine cases of lymph node metastasis, bone metastasis in 5 cases, lung metastases patients. 6-134 months, with an average follow-up follow-up time of 57 months. Recurrence in 21 cases (21.2%), 7 died, four patients died of metastasis, 1 patient died of heart disease, ominous reason two cases. Four cases diagnosed as benign after 23 to 117 months of follow-up found that tumor metastasis. Conclusion paraganglioma occur in the peritoneum, and adrenal pheochromocytoma compared easily prone to recur, malignant high incidence. 24-hour urinary catecholamine determination of sensitivity and specificity were higher qualitative diagnosis. The enhanced CT high sensitivity, can be used as first-line positioning of diagnostic tests. The MIBG check qualitative and positioning diagnostic role, particularly in multiple tumors, recurrent tumors, tumor metastases diagnosis is superior to CT, MRI examination. Surgery is the only cure treatment be satisfied with the therapeutic effect of laparoscopic surgery. Pathological examination can not be as benign and malignant diagnosis is based on a long time close follow-up is necessary.

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