Precise diagnosis and effective management of highly vascular anterior mediastinal paragangliomas: A case report

Mediastinal paragangliomas are rare neoplasms arising from extra-adrenal neural crest cells, presenting as either functional or nonfunctional tumors. Clinical manifestations range from catecholamine-related symptoms to physical compression effects. Accurate recognition of these tumors is crucial for diagnosis and management due to their rarity and association with vital mediastinal structures.

We report the case of a 53-year-old Syrian male presenting with progressive dyspnea, fatigue, and weakness. Imaging revealed a highly vascular anterior mediastinal mass compressing the superior vena cava, diagnosed as a nonfunctional paraganglioma. Preoperative evaluations included endocrine consultation and blood transfusion preparations. The tumor was surgically excised via lateral thoracotomy without complications. Postoperative imaging confirmed the absence of residual mass, and two years of regular follow-ups revealed no recurrence or metastasis.

Mediastinal paragangliomas pose diagnostic and management challenges due to their rarity and potential for extensive vascular involvement. Nonfunctional paragangliomas, in particular, may remain asymptomatic until they exert significant mass effects. Surgical resection is the definitive treatment, often requiring a multidisciplinary approach. Tumor size and patient age influence malignancy risk and recurrence, highlighting the need for thorough perioperative planning and long-term follow-up.

This case underscores the importance of precise diagnosis, meticulous perioperative management, and surgical intervention in managing mediastinal paragangliomas. Lifelong monitoring is essential, especially for larger tumors, to ensure early detection of recurrence. Comprehensive understanding and documentation of such cases contribute to improved patient outcomes and enhanced clinical management strategies.