A case report of a 69-year-old patient with a paraganglioma metastasis to the thyroid gland
Karolina PiechotaDanuta Gąsior‐PerczakPiotr PrzybycieńJanusz KopczyńskiArtur KowalikStanisław GóźdżAldona Kowalska
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Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)Paraganglioma is benign and slow growing neuroectodermal tumor commonly found in the adrenal medulla, carotid body and glomus-jugulare. Paraganglioma of cauda equina is relatively rare.We report a case of paraganglioma of the cauda equina region in 60 year lady who underwent successful surgical resection. Clinical presentation and imaging appearances of paraganglioma involving the spine is nonspecific and most of the time diagnosis is on post operative histopathology. Few MRI features and contrast MRI can be helpful if paraganglioma is suspected.Paraganglioma should be kept in mind as the differential diagnosis of extra medullary tumor contracted in the cauda equina region. Catecholamine secretory paraganglioma is uncommon but preoperative screening for hyper adrenergic state is necessary to prevent hypertensive crises during tumor removal.
Cauda equina
Histopathology
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Paraganglioma of the urinary bladder is rare, accounting for <0.05% of all bladder tumors. Common clinical findings in patients with bladder paraganglioma include hematuria and intermittent hypertension during urination, along with generalized symptoms due to increased levels of catecholamines. Although unsuspected bladder paraganglioma may result in intraoperative hypertensive crises, these may be avoided if characteristic imaging signs are observed. The present study reports a case in which a patient with unsuspected paraganglioma experienced a severe hypertensive episode during cystoscopic tumor resection. Although this case had typical computed tomographic characteristics of the bladder paraganglioma, the possibility of the paraganglioma pre-operatively was not taken into account.
Urination
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Білім берy қоғaмның экономикaлық дaмyының негізі, әлеyметтік тұрaқтылықтың фaкторлaрының бірі, хaлықтың рyхaни-aдaмгершілік әлеyетінің және интеллектyaлдық өсyінің қaйнaр көзі ретінде бaрлық yaқыттaрдa тaптырмaс құндылық болып есептеліп келеді. Aл қaзіргідей aдaм кaпитaлын қaлыптaстырy мен дaмытy мәселесін шешy негізгі міндет ретінде қaрaстырылaтын зaмaндa хaлықтың білімдік қaжеттіліктері өсіп, жоғaры, ортa aрнayлы, кәсіби қосымшa білім aлyғa үміткерлер сaны aртa түсyде. Бұғaн жayaп ретінде білім берy ұйымдaрының сaлaлaнyы aртып, әртүрлі типтегі оқy орындaрының сaны aртyдa, білім берyдің инфрaқұрылымы, бaсқaрy формaлaры, әдістемелік, ғылыми қызмет түрлері дaмyдa. Олaрды білім aлyшылaрдың жеке сұрaныстaры мен мүмкіндіктеріне бaғыттay күшейтілyде. Осығaн орaй білімнің сaпaсынa қойылaтын тaлaптaр aртып, бұл сaлaның әлеyметпен өзaрa әрекеттестігіне негізделген құрылымдық – қызметтік дaмyының көкейтестілігі aртyдa. Мaқaлaдa «серіктестік», «әлеyметтік серіктестік», «білімдегі әлеyметтік серіктестік» ұғым- дaрының мәні aшылып, олaрдың қaлыптaсy және дaмy үрдісіне шолy жaсaлaды, жоғaры оқy орындaрындa педaгогтaрды дaярлayдa әлеyметтік серіктестердің әлеyетін пaйдaлaнyдa бaсшылыққa aлынaтын ұстaнымдaр мен тиімді жолдaры сипaттaлaды. Түйін сөздер: серіктестік, әлеyметтік серіктестік, білімдегі әлеyметтік серіктестік, бірлескен әрекет ұстaнымдaры, әлеуметтік серіктестік әлеуеті. Обрaзовaние является основой экономического рaзвития обществa, одним из фaкторов социaль- ной стaбильности, источником дyховно-нрaвственного потенциaлa и интеллектyaльного ростa людей и во все временa считaлось незaменимой ценностью. И в нaстоящее время, когдa решение проблемы формировaния и рaзвития человеческого кaпитaлa рaссмaтривaется кaк основнaя зaдaчa, рaстyт обрaзовaтельные потребности людей, yвеличивaется количество желaющих полyчить высшее, среднее, специaльное, профессионaльное дополнительное обрaзовaние. В ответ нa это yсиливaется рaзветвленность обрaзовaтельных оргaнизaций, yвеличивaется количество обрaзовaтельных оргaни- зaций рaзличного типa, рaзвивaются инфрaстрyктyрa обрaзовaния, формы yпрaвления, методическaя и нayчнaя деятельность. Yсиливaется их ориентaция нa индивидyaльные потребности и возможности обyчaющихся. В связи с этим повышaются требовaния к кaчествy обрaзовaния, возрaстaет знaчение стрyктyрно-фyнкционaльного рaзвития этой сферы нa основе взaимодействия с обществом. В стaтье рaскрывaется знaчение понятий «пaртнерство», «социaльное пaртнерство», «социaльное пaртнерство в обрaзовaнии», рaссмaтривaется процесс их стaновления и рaзвития, описывaются рyко- водящие принципы и эффективные способы использовaния потенциaлa социaльных пaртнеров в подготовке педaгогических кaдров в высших yчебных зaведениях. Ключевые словa: партнерство, социaльное пaртнерство, социaльное пaртнерство в обрaзовaнии, принципы совместного действия, поненциал социального партнерство. Education is the basis of the economic development of society, one of the factors of social stability, a source of spiritual and moral potential and intellectual growth of people and has always been considered an irreplaceable value. And at the present time, when the solution of the problem of the formation and development of human capital is considered as the main task, the educational needs of people are growing, the number of people wishing to receive higher, secondary, special, professional additional education is increasing. In response to this, the branching of educational organizations is increasing, the number of educational organizations of various types is increasing, the infrastructure of education, forms of management, methodological and scientific activities are developing. Their focus on the individual needs and capabilities of students is increasing. In this regard, the requirements for the quality of education are increasing, the importance of the structural and functional development of this sphere on the basis of interaction with society is increasing. The article reveals the meaning of the concepts of "partnership", "social partnership", "social partnership in education", examines the process of their formation and development, describes the guidelines and effective ways to use the potential of social partners in the training of teachers in higher educational institutions. Keywords: partnership, social partnership, social partnership in education, principles of joint action, the potential of social partnership.
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Objective:To improve clinical diagnostic ability for paraganglioma.Methods:CT scan was performed in 36 patients and MRI were performed in 21.CT and MRI findings in 37 cases (43 lesions) with pathologically-proved paraganglioma were retrospectively analyzed.Of 43 lesions,32 were adrenal pheochromocytoma, 8 were extra-adrenal paraganglioma and 1 was carotid body paraganglioma.Results:The largest diameters of adrenal pheochromocytoma and extra-adrenal paraganglioma were more than 5cm.Necrosis and cystic degeneration were common findings(23/43).CT findings were of middle density.The signal intensity on T_1WI was similar to that of hepatic parenchyma,while on T_2WI was marked hyper-intensity.Usually, the tumorous parenchyma showed strong enhancement.A case of carotid body paraganglioma showed uniform intensity,with no necrosis and cystic formation.The feature and degree of enhancement were similar to that of the carotid artery.Conclusion:The CT and MRI findings of paraganglioma carry certain characteristics.For most cases,a reliable diagnosis can be made when combined with clinical information.
Parenchyma
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Paraganglioma are tumours arising from neural crest cells of the sympathetic and parasympathetic paraganglia. Functional paraganglioma presents with symptoms of catecholamine excess that includes hypertension, flushing, diaphoresis, etc. Non-functional paraganglioma are usually found incidentally during imaging studies. Early diagnoses of functional paraganglioma are important because their removal is often curative. We present the case of a young man who presented with hypertensive crisis and severe headache, who was later found to have functional paraganglioma.
Hypertensive crisis
Functional Imaging
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症例：70代女性．冠動脈CTにて偶然，十二指腸に腫瘤を指摘された．精査の腹部造影CTでは十二指腸と一部接する境界明瞭な腫瘤で，早期から強く造影され，後期まで造影効果は遷延していた．MRIでは嚢胞を含み，T2強調像にて不均一な高信号を呈していた．脂肪は見られなかった．十二指腸消化管間質腫瘍のほかに，後腹膜神経鞘腫，paragangliomaを鑑別に挙げた．このため，123I-MIBGシンチグラフィを行ったところ有意な集積を認めた．手術後の病理標本でもparagangliomaの診断であった．
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Chemodectoma
Confusion
Glomus tumor
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Paraganglioma normally occurs in sites that parallel the
sympathetic and parasympathetic chain ganglions. Common
locations of paraganglioma include tumours of paraganglionic
system in head and neck region like carotid body paraganglioma
and jugulotypmanic paraganglioma. There are also paragangliomas
that occur outside the usual distribution of sympathetic and
parasympathetic paraganglia. Pathological diagnosis of paraganglioma
depends on the characteristic histological features and
immnohistochemical detection of neuroendocrine marker(s).
Composite paragangliomas (paragangliomas with features of
ganglioneuroma or ganglioneuroblastoma) are sometimes
noted. The malignant potential of paraganglioma is difficult
to be assessed. Assessment systems have been proposed
in the pathology reporting of paraganglioma in order to predict
the malignant behaviour of the tumour. In this context, proliferative
activity obtained from Ki-67 immunohistochemical
staining should be provided in the reporting of paraganglioma.
Recent developments in molecular genetics have expanded
the spectrum of disorders associated with paragangliomas.
The relevant clinical impact in pathology is the role of pathologist
in the detection of SDHB by immunohistochemistry in
paraganglioma as SDHB mutations are strongly correlated with
head and neck paraganglioma, presence of metastasis and poor
prognosis. A high index of suspicion should be applied as
paraganglioma occur in diverse sites. Also, awareness of the
need of updated pathological and immunological data are essential
for proper management of patients with paraganglioma.
SDHB
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