General NM case of the month (11/09): Recurrent Paraganglioma
A 65 yrs old male was found to have extremely high blood pressure during work
up for pacemaker placement. Subsequent biochemical studies revealed
elevated urine and plasma cathecolamine metabolites. Patient has past medical
history of right sided retroperitoneal paraganglioma resected 23 years ago.
Suspected to have a recurrent paraganglioma or new pheochromocytoma,
patient was referred for an MIBG scan to localize the tumor and possible
metastasis. Whole body images show focal abnormal uptake in the right
paramedian midabdomen.
up for pacemaker placement. Subsequent biochemical studies revealed
elevated urine and plasma cathecolamine metabolites. Patient has past medical
history of right sided retroperitoneal paraganglioma resected 23 years ago.
Suspected to have a recurrent paraganglioma or new pheochromocytoma,
patient was referred for an MIBG scan to localize the tumor and possible
metastasis. Whole body images show focal abnormal uptake in the right
paramedian midabdomen.
I-123 MIBG SPECT-CT demonstrates a focus of markedly increased uptake in
the abdomen, corresponding to a soft tissue mass in the right retroperitoneal
paracaval region just superior to the right renal vessels. Mild physiologic
uptake is seen in the normal adrenals. The tumor and the right adrenal gland
were surgically removed without complications. Pathology identified malignant
paraganglioma in the tumor and the normal adrenal. MIBG SPECT-CT helped
localize recurrent paraganglioma for surgical resection.
the abdomen, corresponding to a soft tissue mass in the right retroperitoneal
paracaval region just superior to the right renal vessels. Mild physiologic
uptake is seen in the normal adrenals. The tumor and the right adrenal gland
were surgically removed without complications. Pathology identified malignant
paraganglioma in the tumor and the normal adrenal. MIBG SPECT-CT helped
localize recurrent paraganglioma for surgical resection.
1. Detection and treatment of pheochromocytomas and paragangliomas:
current standing of MIBG scintigraphy and future role of PET imaging.
Havekes B, Lai EW, Corssmit EP, Romijn JA, Timmers HJ, Pacak K. Q J Nucl
Med Mol Imaging. 2008 Dec;52(4):419-29.
2. Scintigraphic imaging of body neuroendocrine tumors. Intenzo CM, Jabbour
S, Lin HC, Miller JL, Kim SM, Capuzzi DM, Mitchell EP. Radiographics. 2007
Sep-Oct;27(5):1355-69.
This case was compiled by Dr. David He, BCM
current standing of MIBG scintigraphy and future role of PET imaging.
Havekes B, Lai EW, Corssmit EP, Romijn JA, Timmers HJ, Pacak K. Q J Nucl
Med Mol Imaging. 2008 Dec;52(4):419-29.
2. Scintigraphic imaging of body neuroendocrine tumors. Intenzo CM, Jabbour
S, Lin HC, Miller JL, Kim SM, Capuzzi DM, Mitchell EP. Radiographics. 2007
Sep-Oct;27(5):1355-69.
This case was compiled by Dr. David He, BCM
