Challenges in peri-aortic paraganglioma management

Paragangliomas are extra adrenal tumors composed of chromaffin cells that can secrete catecholamines. Retroperitoneal paragangliomas are a rare entity that develop anywhere along the midline of the retroperitoneum. Surgical resection is the mainstay of treatment. However, resection of para-aortic retroperitoneal paraganglioma is extremely challenging due to their close association with major abdominal vessels. We encountered a challenging case, where the tumor was closely adherent to inferior vena cava and portal vein, and the initial attempt for tumor resection was aborted due to hypertensive crisis. Additionally, treatment with radiation wasn't effective in shrinking the tumor, raising the question of radio sensitivity of these tumors.