Compromiso ganglionar para-aórtico en estadios tempranos de cáncer de endometrio de acuerdo con el algoritmo de Kumar y col / Para-aortic ganglionic involvement in early stages of endometrial cancer according to the algorithm of Kumay et al

Introducción: La linfadenectomía para-aórtica en pacientes con estadios tempranos de cáncer de endometrio continúa siendo controversial, debido a que algunos estudios sugieren mayor morbilidad y costo sin claro beneficio en la sobrevida global. Objetivo: determinar el compromiso ganglionar para-aórtico en pacientes con cáncer de endometrio en estadios tempranos de acuerdo con él algoritmo de Kumar y col. Método: estudio descriptivo retrospectivo tipo serie de casos que incluyó pacientes llevadas a cirugía clasificatoria por vía abierta o laparoscópica (histerectomía total, salpingo-oforectomía bilateral más linfadenectomía pélvica y para-aórtica) con diagnóstico de adenocarcinoma de endometrio tipo endometriode, aplicación del algoritmo y evaluación de las diferencias que resultaran. Resultados: se incluyeron 15 pacientes, de las 9 clasificadas por el algoritmo de Kumar y col. como de alto riesgo en 2 (28.5%) hubo compromiso ganglionar para-aórtico (GPA) y en ninguna en el grupo de bajo riesgo. Cuatro (26,6%) pacientes presentaron complicaciones derivadas del procedimiento, 75% fueron tempranas, una ingresó a la unidad de cuidado intensivo (UCI) y no hubo muertes asociadas con los procedimientos quirúrgicos. Conclusión: las pacientes de bajo riesgo según el algoritmo de Kumar y col. fueron negativas para compromiso GPA, sin embargo, no ocurrió lo mismo para las de alto riesgo, por lo cual no podemos recomendar el uso rutinario de la realización de la linfadenectomía para-aórtica. Tendrán que realizarse estudios prospectivos para validar este algoritmo con el número de pacientes con el que fue planteado.

Introduction: Controversy persists on the benefit of para-aortic lymphadenectomy in patients with early-stage endometrial cancer, for some trials suggest increased morbidity and costs showing no clear benefit for overall survival. Objective: to determine para-aortic lymph node metastases (LNM) in patients with early-stage endometrial cancer according to the Kumar et al. risk classification algorithm. Method: a case series descriptive retrospective study was conducted in patients who underwent open or laparoscopic staging surgical procedures (total hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy), diagnosed with endometrioid endometrial adenocarcinoma, classified by the risk algorithm and analysis of their outcomes. Results: a total of 15 patients were included, of the 9 patients classified as high risk by the Kumar et al algorithm, 2 (28.5%) had para-aortic LNM, and no patients in the low risk group had LNM. Four (26.6%) patients had postoperative complications, 75% were early complications, one patient was admitted to the intensive care unit (ICU) and there were no deaths related to the surgical procedures. Conclusion: low risk patients classified by the Kumar et al algorithm had no para-aortic LNM however high risk patients had different results. We cannot therefore recommend routine para-aortic lymphadenectomy. Further prospective clinical trials must be conducted for validation of this algorithm with the same number of patients with which it was proposed.

Paraganglioma metastásico: imagen con 18F-fluordesoxiglucosa-tomografía por emisión de positrones / Metastatic paraganglioma: image with F18-FDG- PET/CT

Los paragangliomas son tumores neuroendocrinos poco frecuentes que pueden originarse en cualquier lugar a lo largo del sistema paraganglial. La mayoría son benignos y de progresión lenta, sin embargo un 10% aproximadamente presentan metástasis. El 80-85% de estos tumores surgen de la médula suprarrenal y se nombran feocromocitomas, mientras que el 15-20% se encuentran en tejidos cromafines a nivel extra-adrenal y se conocen como paragangliomas. Tienen variantes hereditarias (25%), también pueden manifestarse con multifocalidad. Pueden aparecer en cualquier parte del sistema paraganglial y estar asociados con el tejido nervioso simpático (médula adrenal, el órgano de Zuckerkandl, u otras células cromafines que puedan persistir más allá de la embriogénesis), o con el sistema nervioso parasimpático (quimiorreceptores, que se encuentra principalmente en cabeza y cuello). Por lo tanto, los paragangliomas pueden estar distribuidos desde la base del cráneo hasta el sacro. Las imágenes de medicina nuclear ayudan a delinear plenamente la enfermedad.

The paragangliomas are a rare neuroendocrine group of tumors that can occur anywhere along paraganglia system. Most of them are benign and of slow progression, however about 10% of them will have metastases. The large majority (80-85%) of these tumors arise from the adrenal medulla and are called pheochromocytomas, while 15-20% originate in chromaffin tissue at extra-adrenal sites, and are called paragangliomas. There are inherited variants (25%), and the disease may also present with multifocality. They can appear anywhere in paraganglia system and may be associated with sympathetic nervous tissue (adrenal medulla, the organ of Zuckerkandl, or other chromaffin cells that can persist beyond embryogenesis), or the parasympathetic nervous system (chemoreceptors, which are found mainly in the head and neck). Therefore, paragangliomas can be distributed from the base of the skull to the sacrum. Nuclear medicine imaging can help to fully define the disease. © 2013 Instituto Nacional de Cancerología. Published by Elsevier España, S.L. All rights reserved.

Paraganglioma del órgano de zuckerkandl / Paraganglioma of the organ of zuckerkandl

Los paragangliomas del órgano de Zuckerkandl son un problema clínico infrecuente. Aunque los pacientes presentan síntomas característicos, como hipertensión arterial de difícil manejo, cefalea y palpitaciones, su diagnóstico se debe considerar de exclusión. En este artículo se hace una revisión de la literatura y se presenta con caso clínico.

Paragangliomas of the Organ of Zuckerkandl constitute an infrequent clinical problem. Although the patients present with the classical triad of hypertension, headaches and palpitations, they should always be considered by exclusion diagnosis. This article includes a literature review and a case presentation.

Abordaje laparoscópico transperitoneal de feocromocitomas y paragangliomas / Transperitoneal laparsoscopic surgery for pheochromocytomas and paragangliomas

Los feocromocitomas adrenales y extra-adrenales o paragangliomas funcionantes constituyen una causa inusual de hipertensión arterial pasible de ser tratada mediante el tratamiento laparoscópico...El abordaje laparoscópico de feocromacitomas adrenales funcionantes constituye un método seguro y efectivo, siendo considerado actualmente el procedimiento de elección. Los avances de los métodos por imágenes de localización pre-operatoria y el continuo desarrollo quirúrgico laparoscópico permitirán, en un futuro no muy lejano, imponer el acceso laparascópico también como vía de elección en feocromocitomas extra-adrenales o paragangliomas. La alta incidencia de bilateralidad y compromiso extraadrenal justifica, a nuestro entender, la triple evaluación imagenológica (TAC-RMN-Centellografía MIBG) en todos los pacientes.

Short course of para-aortic irradiation for patients with stage I seminoma of the testis

Adjuvant postoperative para-aortic lymph nodal irradiation is an acceptable alternative to para-aortic and ipsilateral pelvic irradiation post-orchiectomy for patients with stage I seminoma of the testis. In this article, we report the results of retro-spective evaluation of para-aortic irradiation only for such patients. In a private hospital between June 1995 and June 2006, 23 patients with Stage I seminoma were treated with adjuvant irradiation to the para-aortic region only after radical inguinal orchiectomy. Radiotherapy was delivered using parallel-opposed fields extending from T11 to L4. A total dose of 25-30 Gy in 15 fractions was prescribed to midpoint. Follow-up was performed every 3 months for the first year, every 4 months for the second and third years, every 6 months for the fourth and fifth years, and annually thereafter. Chest X-ray, lactate dehydrogenase, tumor markers, and computed tomography scan of the pelvis were performed routinely as part of the follow-up investigations. At a median follow-up of 39 months, all patients arc alive and free of relapse. The actuarial 5-year relapse free survival is 100%. No late toxicity has been encountered. None had developed second malignany during the follow-up period. Patients with Stage I seminoma of the testis may be safely treated with para-aortic radiotherapy only. Risk of pelvic failure is very low and treatment toxicity minimal

Pheochromocytoma of the organ of Zuckerkandl. Unusually small lesion detected with magnetic resonance imaging

A case report of a 40-year-old female with an unusually small pheochromocytoma of the organ of Zuckerkandl is discussed. The tumor is diagnosed by magnetic resonance imaging MRI examination, which was requested to evaluate her as a potential renal donor. There is a family history of Carney s triad gastric leiomyosarcoma, extra-adrenal pheochromocytoma and pulmonary chondroma. The MRI technique and findings are discussed

A Case of Retroperitoneal Paraganglioma Accompanying Bile Duct Dilatation / 대한소화기내시경학회지

Retroperitoneal paraganglioma is a kind of uncommon tumor that occurs most commonly in the organ of Zuckerkandl located in the paraaortic area between the origin of the inferior mesenteric artery and the origin of the iliac artery. We experienced a case of retroperitoneal paraganglioma with an unusual location in a 52-year-old woman who had epigastric pain. Abdominal CT scan and ERCP showed a hypervascular mass near the distal CBD with bile duct dilatation. The surgically resected mass was diagnosed as paraganglioma. We report this unusual retroperitoneal paraganglioma, with a review of the literature.

Mesenteric Paraganglioma with Cystic Degeneration: Case Report

Extra-adrenal abdominal paragangliomas are rare. Most arise from the organs of Zuckerkandl, involve large concentrations of paraganglionic tissue, and are located in the para-aortic space along the sympathetic chain. Published reports have, however, described normal paraganglionic tissue at the root of the mesentery which serves as the superior limit of the organs of Zuckerkandl, and mesenteric paraganglioma is very rare. We report a case of paraganglioma with cystic degeneration arising from the mesentery.

The paraganglioma, zuckerkandl tumor on occasion of one case, review of medical documen

A male patient with age of 29, hypertension, headache, palpitation, sweating was detected the tumor in the left wall of the abdominal aorta. The tumor was removed by operation in Viet Duc hospital in 12th October 1999. The results of anatomy also found that the preoprative diagnosis of the paraganglioma, zuckerkandl tumor.

Paraganglioma Arising from Retroperitoneum, Mediastinum

A paraganglioma that arises from the Retroperitoneum, mediastinum is an extra-adrenal form of pheochromcytoma. Extra-adrenal pheochromocytomas can occur at any site in the abdomen where chromaffin tissue is located and have been found in the paravertebral ganglia, the organ of Zuckerkandl, and the urinary bladder. An extra-adrenal pheochromocytomas can arise from a collection of para-aortic, paraganglion cells located at the origin of the inferior mesenteric artery, This collection of paraganglia was first described in fetuses by Zuckerkandl in 1901 and has subsequently been referred to as the organ of Zuckerkandl. Extra-adrenal pheochromocytoma generally secrete norepinephrine, not epinephrine, because there is an absence of the enzyme phenyl- ethanolamine-N-methyl transferase. Therefore symptoms are related to the production of norepinephrine. Extra-adrenal pheochromocytomas pursue a more aggressive course than their adrenal counterparts. It was found to metastasize in approximately 20% to 40% of cases, compared with only a 2% to 10% rate of metastasis in all adrenal tumors. We report on a three case of paragangliomas that had a functional and non-functional paraganglioma of the organ of Zuckerkandl and a case of a non-functional paraganglioma of the posterior mediastinum.

Nerepinephrine Secreting Pheochromocytoma in the Organ of Zuckerkandl With Epinephrine Granules in Cytoplasm / 대한내분비학회지

Extraadrenal pheochromocytomas developed from the paraganglia other than adrenal medulla are uncommon tumors. Such lesions have been reported that as much as 10% of retroperitoneal paragliomas arise outside the adrenal gland. But their incidence and prognosis are changing partly as a result of progression in developmental mechanism, diagnostic tools and concepts including ultrastructure, immunohistochemistry. The ultrastructure of chromaffine neoplasm from adrenal and extraadrenal tissues has been studied with chrarnaffine granule specificity and type of catecholamine content. With rare exceptions, extraadrenal chrornaffine tumor mainly has high concentration of norepinephrine which is suggested as dict relationship to numoruos electrone dense granular bodies in the cell cytoplasrn. High or intermediate level of epinephrine in tissue is associated with cytoplasmic granular bodies of much less density, Recently we experienced the exception, a case of norepinephrine secreting pheochrom-ocytoma in the organ of Zuckerkandl with epinephrine granules in cytoplasm and this discrepancy probably due to the plasticity

Extraadrenal Retroperitoneal Paragangliomas: Radiologic Pathologic Correlation

PURPOSE: Retroperitoneal paraganglioma is a relatively uncommon neurogenic tumor, arising from paraganglial tissue. In our knowledge, there is few report about the radiologic findings of extraadrenal paraganglioma, therefore, here we document the adiologic findings of retroperitoneal paraganglioma with pathologic correlation. MATERIALS AND METHODS: In 5 patients with surgicopathologically confirmed extraadrenal paraganglioma and 1 clinjcolaboratorily confirmed case, we analyzed the ultrasonographic, computed tomographic and MRI findings, and correlated them with gross pathologic specimen. RESULTS: The location of the tumors was medial aspect of left kindey(n=2), superomedial aspect of right kidney hilum(n=2), and organ of Zuckerkandl area(n=2), UItrasonoram showed well-marginated mass(n=5), occasionally with irregular central necrosis with or without partially echogenic area suggesting hemorrhage(n=2). CT scan also showed well-marginated mass(n=6) with hemorrhagic necrosis(n--3) and contrast enhancement. One showed are shaped calcification along the capsule, and another case showed adhesion with aorta. In MRI, solid portion of the mass showed relatively low signal intensity on T1WI, increased signal on T2WI, and enhancement with gadolinium. Necrotic portion showed increased signal intensity on T1WI, and also showed increased signal intensity on T2WI, without contrast enhancement. Grossly the mass showed internal hemorrhagic necrosis of variable degree(n=6). CONCLUSION: If well-marginated mass is noted around the area of paraganglial distribution including organ of Zuckerkandl, especially with evidence of hemorrhagic necrosis and contrast enhancement, we must consider the possibility of paraganglioma despite no characteristic symptoms.

Nonfunctioning paraganglioma arising from the organ of Zuckerkandl

No abstract available.

Características anatómicas macroscópicas y microscópicas del cuerpo paraaórtico en fetos humanos de término / Macroscopic and microscopic anatomic characteristics of the paraaortic body in human fetuses at term

Se hace un estudio detallado de las características anatómicas macroscópicas y microscópicas que presentan los cuerpos paraaórticos en 50 fetos humanos de término de ambos sexos, en los que se practicó la disección bilateral, teniendo como base la observación directa con la ayuda de un microscopio de operaciones Carl Zeiss. Se dan detalles de la cantidad de cuerpos paraaórticos existentes, de sus formas, pesos y volúmenes totales, como también de sus dimensiones y las orientaciones de ellas. Se establece su ubicación, relaciones y conexiones al igual que la vascularización arterial y venosa. Se determina su estructura macroscópica y microscópica, recalcando su significación anátomo-funcional

Pheochromocytoma Arising from the Organ of Zuckerkandl Associated with Intracerebral Hemorrhage: 1 case report

Pheochromocytoma is a hazardous and dramatic cause of hypertension. This potentially lethal neoplasm originates in most cases in the adrenal medulla and less frequently in the cells of the extraadrenal paraganglion system which are disseminated along the paravertebral axis from the pelvis to the base of the skull. The organ of Zuckerkandl is paraganglia lying the abdominal aorta with highest incidence in the region of the inferior mesenteric artery and usually degenerate shortly after birth. In the literature, and additional one case of pheochromocytoma arising from the organ of Zuckerkandl associated with intracerebral hemorrhage which was treated recently in the Kyung Hee University Hospital is presented in this report.