A Case of Retroperitoneal Paraganglioma with an Absent Celiac Trunk Successfully Resected Laparoscopically

Abstract

A 48-year-old man had a medical checkup for an abnormality detected on abdominal US and visited our hospital. Abdominal CT showed a tumor with a diameter of 3 cm behind the body of the pancreas and the common hepatic artery, which was heterogeneously enhanced and had a smooth surface and clear border. The celiac trunk was absent, so that the superior mesenteric artery supplied the splenic artery, hepatic artery, and left gastric artery. On MRI, the tumor appeared low intensity on T1WI and high intensity on T2WI, which was persistently enhanced with contrast medium. Because blood catecholamine levels were normal in all three fractions, the lesion was considered a non-functioning paraganglioma, and it was resected laparoscopically. Lifting the stomach by a Penrose drain secured a wide operative field, and it could be dissected from the retroperitoneum. The tumor had abundant blood flow and was surrounded by major arteries, making it hard to remove. Thus, it was necessary to cut the splenic artery to resect it laparoscopically. Because immunohistochemical examination showed that tumor cells were positive for synaptophysin and S-100 protein, the pathological diagnosis was paraganglioma. In properly selected patients, a laparoscopic approach to a retroperitoneal tumor is considered a safe and feasible procedure.