Therapy of Spinal Paragangliomas – Case Reports

Czech version

Authors: L. Hrabálek ¹; O. Kalita ¹; M. Adamus ²; J. Macháč ¹; M. Zlevorová ³; T. Wanek ¹
Authors‘ workplace: LF UP a FN Olomouc Neurochirurgická klinika ¹; LF UP a FN Olomouc Klinika anesteziologie a resuscitace ²; LF UP a FN Olomouc Onkologická klinika ³
Published in: Cesk Slov Neurol N 2012; 75/108(5): 626-629
Category: Case Report

Overview

Spinal paragangliomas are uncommon tumors. Vast majority of these tumours present as spinal intradural extramedular tumours in the filum terminale/cauda equina region, less frequently extradurally. Authors present case reports of two male patients with tumours of the lumbar spine. Typically intradurally (L1–L2) located tumour in the first, 28 years old patient, was completely surgically removed. The second, 68 years old patient, had an advanced paraganglioma located atypically extradurally and retroperitoneally at the level of L4. The tumour was partially resected using a combined approach and vertebral body was replaced. Radiotherapy followed. In both cases, local recurrence or metastases have not been found so far and neurological status improved. Surgical resection of advanced spinal paragangliomas is difficult, since the tumour is highly vascularized. The combination of surgery with postoperative radiotherapy is an ideal curative modality for incompletely removed or recurrent tumours. Chemotherapy and treatment with ¹³¹I-metaiodobenzylguanidine seem to be less effective and are used for malignant metastatic lesions.

Key words:
paragangliomas – lumbar spine – spinal surgery – radiotherapy

Sources

1. Kwan RB, Erasmus AM, Hunn AW, Dubey A, Waites P, Jessup PJ et al. Pre-operative embolisation of metastatic paraganglioma of the thoracic spine. J Clin Neurosci 2010; 17(3): 394–396.

2. Richter A, Halm HF, Lerner T, Liljenqist UR, Quante M. Long-term follow-up after en bloc resection and reconstruction of a solitary paraganglioma metastasis in the first lumbar vertebral body: a case report. J Med Case Rep 2011; 5: 45.

3. Shin JY, Lee SM, Hwang MY, Sohn CH, Suh SJ. MR findings of the spinal paraganglioma: report of three cases. J Korean Med Sci 2001; 16(4): 522–526.

4. Laufer I, Edgar MA, Hartl R. Primary intraosseous paraganglioma of the sacrum: a case report. Spine J 2007; 7(6): 733–738.

5. Boriani S, Chevalley F, Weinstein JN, Biagini R, Campanacci L, De Iure F et al. Chordoma of the spine above the sacrum. Spine 1996; 21(13): 1569–1577.

6. Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Tiribatake Y. Total en bloc spondylectomy. Spine 1997; 22(3): 324–333.

7. Blin V, Picquet J, Enon B, Rohmer V. Secreting paraganglioma of the organ of Zuckerkandl. A case report. J Mal Vasc 2002; 27(4): 239–242.

8. Enzinger FM, Weiss SW. Liposarcoma. Soft-tissue tumors. 2nd ed. Washington D.C.: The C.V. Mosby Company 1988: 836–860.

9. Farthouat P, Platel JP, Meusnier F, Pourriére M, Thouard H. Secreting retroperitoneal paraganglioma. Apropos of a case. J Chir (Paris) 1997; 134(5–6): 248–251.

10. Patel SR, Winchester DJ, Benjamin RS. A 15-year experience with chemotherapy of patients with paraganglioma. Cancer 1995; 76(8): 1476–1480.

11. Mariman EC, van Beersum SE, Cremers CW, van Baars FM, Ropers HH. Analysis of os second family with hereditary non-chromaffin paragangliomas locates the underlying gene at the proximal region of chromosome 11q. Hum Genet 1993; 91(4): 357–361.

12. Aghakhani N, George B, Parker F. Paraganglioma of the cauda equina region – report of two cases and review of the literature. Acta Neurochir (Wien) 1999; 141(1): 81–87.

13. Buonuomo V, Ruggiero A, Rando G, D´Urzo C, Manzoni C, Pintus C. Malignant retroperitoneal paraganglioma: case report and review of the literature. Pediatr Hematol Oncol 2004; 21(8): 731–738.

14. De Roeck C, Petein M, Lurquin P, Hansen M, Mendes de Costa P. Malignant retroperitoneal paraganglioma. Case report and literature review. Acta Chir Belg 1992; 92(4): 181–186.

15. Hruby G, Lehman M, Barton M, Peduto T. Malignant retroperitoneal paraganglioma: Case report and review of treatment options. Australasian Radiology 2000; 44(4): 478–482.

16. Buchvald P, Jurák L, Mikuláštík J, Beneš V, Suchomel P. Paragangliomy kaudy a filum terminale. Neurol Prax 2011; 12(4): 286–289.

17. Duet M, Herman P, Wassef M, Huy PTB, Laredo JD. Bone metastases from head and neck paragangliomas: uncommon MR findings in an uncommon condition – report of three cases. J Magn Reson Imaging 2006; 24(2): 428–433.

18. Lee JH, Barich F, Karnell LH, Robinson RA, Zhen WK, Gantz BJ et al. American College of Surgeons commission on Cancer; American Cancer Society. National Cancer Data Base Report on malignant paragangliomas of the head and neck. Cancer 2002; 94(3): 730–737.

19. Lehmen JA, Babbel DM, Mikhitarian K, Choma TJ. Paraganglioma presenting as metastatic lesion in a cervical vertebra: a case report and review of the literature. Spine 2010; 35(5): E152–154.

20. Sclafani LM, Woodruff JM, Brennan MF. Extraadrenal retroperitoneal paragangliomas: natural history and response to treatment. Surgery 1990; 108(6): 1124–1130.

21. Singh NG, Sarkar C, Sharma MC, Garg A, Gaikwad SB, Kale SS et al. Paraganglioma of cauda equina: report of seven cases. Brain Tumor Pathol 2005; 22(1): 15–20.

22. Razakaboay M, Maillefert JF, Wendling D, Juvin R, Toussirot E, Tavernier C et al. Bone metastases from a paraganglioma. A review of five cases. Rev Rhum Engl Ed 1999; 66(2): 86–91.

23. Hamilton MA, Tait D. Metastatic paraganglioma causing spinal cord compression. Br J Radiol 2000; 73(872): 901–904.

24. Schild SE, Foote RL, Buskirk SJ, Robinow JS, Bock FF, Cupps RE et al. Results of radiotherapy for chemodectomas. Mayo Clin Proc 1992; 67(6): 537–540.