A Paraganglioma with Elevated Blood Pressure during Gastrectomy for Gastric Cancer

Abstract

A 68-year-old man received endoscopic treatment of gastric cancer, of which pathology found vascular invasion positive. Abdominal CT scan showed a tumor with clear boundary and heterogeneous inner part.

The tumor, 38×14mm in diameter, was located between the abdominal aorta and the inferior vena cava. The possible diagnosis was a retroperitoneal tumor such as para-aortic lymphadenopathy or schwannoma. Gastrectomy and simultaneous removal of the tumor were scheduled. When we were going to remove the tumor, his blood pressure elevated extremely, so the surgery was discontinued. The urine examination revealed increased amounts of catecholamines, an abdominal MRI showed the high intensity tumor on T2-weighted image, and a MIBG scintigraphy showed the uptake of MIBG to the tumor. Paraganglioma was thus diagnosed. The re-operation was carried out two weeks later. When we started to remove the tumor, his blood pressure fluctuated slightly, but became stable after its blood vessel dissection. The tumor removal followed by curative operation for gastric cancer was performed without problems. The pathological diagnosis was paraganglioma. Paraganglioma is a rare tumor.

Even if blood pressure is normal and the patient is asymptomatic, it is necessary to keep a paraganglioma in mind when a para-aortic tumor is detected.