A Case of Paraganglioma of the Anterior Sacral Region Diagnosed Preoperatively and Treated with Laparoscopic Resection

Abstract

A 78-year-old woman presented to the hospital with a weight loss of 6 kg over one year. Abdominal contrast-enhanced computed tomography (CT) revealed a 26 × 24 mm mass in the presacral area, showing heterogeneous enhancement in the arterial phase. The tumor appeared to have a feeding artery originating from the right common iliac artery. Enhanced magnetic resonance imaging (MRI) demonstrated iso-intensity on T1-weighted images and slightly high intensity on T2-weighted images. Metaiodobenzylguanidine (MIBG) scintigraphy showed hyperintensity in the mass, and elevated levels of blood catecholamines and urinary metanephrines were also noted. Based on these findings, a diagnosis of paraganglioma was made. The patient underwent laparoscopic resection of the tumor following preoperative administration of α-1 receptor antagonists and adequate blood pressure control. The tumor appeared to originate from the hypogastric nerve, necessitating the transection of both the hypogastric nerve and the superior hypogastric nerve plexus. Despite a slight decrease in blood pressure occurring when the feeding vessel was resected, the tumor was successfully removed with careful dissection to avoid direct manipulation of the tumor itself. Laparoscopic surgery, with its magnifying effect and precise dissection using laparoscopic forceps, proved to be useful in this procedure.