Metastatic Paraganglioma With a Fatal Outcome Following Liver Biopsy: A Case Report

Paragangliomas are rare neuroendocrine tumors that may present as hormonally active or silent masses. While generally indolent, they may metastasize and lead to severe complications, particularly when biopsied or manipulated without prior diagnosis. We describe a 53-year-old woman with a history of hypertension, diabetes, and dyslipidemia, admitted for investigation of constitutional symptoms and lytic vertebral lesions. Imaging revealed liver and bone metastases, a retroperitoneal mass, and adenopathy. A liver biopsy was performed, after which she developed hemorrhagic shock due to active hepatic bleeding. Despite successful embolization, she progressed to multiorgan failure, extensive intestinal ischemia, and death. Histological analysis revealed metastatic paraganglioma. This case highlights the diagnostic and therapeutic challenges associated with occult, functionally active paraganglioma. Invasive procedures in undiagnosed neuroendocrine tumors may trigger life-threatening complications, especially in hormonally active lesions. A routine biochemical evaluation is recommended before biopsy, as early recognition of paraganglioma in retroperitoneal masses, even when asymptomatic, is essential to prevent fatal outcomes.