Severe headache presenting as an early sign of retroperitoneal para aortic paraganglioma.

BACKGROUND: Paraganglioma is a rare type of neuroendocrine tumor with the ability to secrete neuropeptide and catecholamines in excess. Sympathetic hyperactivity, severe persistent headache and hypertension is the most common clinical presentation of paraganglioma similar to pheocromocytoma. Case report We reported a case of 19 year old girl with severe headache and hypertension, from past 6 month. On further imaging evaluation for the headache, the computed tomography of the abdomen plus pelvis was suggestive of left pre para aortic paraganglioma measuring of 3.4 cm in diameter. Surgical excision of mass was done. Histopathological examination of surgical specimen was consistent with the diagnosis of paraganglioma. Patient is on regular follow up without any subjective or objective evidence of the disease. CONCLUSION: Retroperitoneal paraganglioma may be one of the causes for commonly occurring symptomatic headache, which is benign in nature, but possibility of transformation of malignant paraganglioma can occur. The surgical excision of mass is the treatment of choice.

Carcinoembryonic antigen directed PET-CECT scanning for postoperative surveillance of colorectal cancer.

AIM: During the follow-up of surgically resected colorectal cancer (CRC), positron emission tomography-contrast-enhanced computed tomography (PET-CECT) is indicated for asymptomatic elevation of carcinoembryonic antigen (CEA) > 5 ng/ml and no obvious site of recurrence on clinical examination and basic imaging. As an institutional policy, a PET-CECT scan was performed at our institute whenever (1) CEA levels rose above 5 ng/ml and (2) CEA values were doubled (even if the CEA level was < 5 ng/ml). Our aim was to correlate the range of CEA elevation with recurrence rates and to evaluate the diagnostic utility of PET-CECT scanning in this setting. METHOD: We retrospectively analysed all cases where a PET-CECT scan was performed for elevated CEA levels during surveillance visits after complete resection of the primary tumour followed by adjuvant therapy. This study was conducted from 1 January 2013 to 31 July 2015. RESULTS: In all, 104 patients underwent a PET-CECT scan for rising CEA values, and 62 patients (59.6%) were found to have recurrent disease. At CEA levels < 5, 5.1-10, 10.1-15, 15.1-50 and > 50 ng/ml, disease recurred in 10%, 45%, 70%, 94% and 100% patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of the PET-CECT scan were 92.7%, 95.2%, 96.2% and 90.9%, respectively. Elevation of CEA levels during follow-up was indicative of recurrence in 68% of the secretors and 45% of the non-secretors (based on baseline CEA status). CONCLUSION: In the setting of rising CEA levels during follow-up of patients with CRC, a PET-CECT scan is a valuable tool to detect recurrence, irrespective of the baseline CEA secretor status. The likelihood of recurrence of disease was directly proportional to the value of the raised CEA level.