Posterior mediastinal paraganglioma presenting with hypertension and back pain in a young adult

Paragangliomas are rare neuroendocrine tumors that secrete neuropeptide and catecholamine. The majority of these tumors are benign, while approximately 10% are malignant. In the thoracic cavity they usually occur in the aorta-sympathetic area and posterior mediastinum. Functional paragangliomas present with paroxysmal hypertension, palpitation, and headache due to increased catecholamines [1]. Nonfunctional ones are usually postoperatively diagnosed and they have mediastinal, pulmonary or endobronchial origin [2]. As in our case, it can be present with hypertension in a young adult. We wanted to present this case because it is a rare case in terms of thoracic surgeons and the procedure was performed with a minimally invasive surgical technique.
A 24-year-old male patient had a history of arterial hypertension and tachycardia for the first time at the age of 20. The highest blood pressure of the patient was 180/90 and the pulse rate was 118 per minute. He was diagnosed with hypertension attacks, back pain, tachycardia and headache. He had a urine vanillylmandelic acid (VMA) level of 14.7 mg/24 hours due to pheochromocytoma. Contrast-enhanced chest MRI showed a 3.8 × 2 mm diameter, high vascularized and contrasted mass in the left para-aortic area at the end of the diaphragm (Fig. 1). Positron emission tomography-computed tomography (PET-CT) and metaiodobenzylguanidine (MIBG) scintigraphy were performed at an external center and they did not show active involvement in the mass. There was no maximum standard uptake (SUVmax) value. No areas of involvement in other parts of the body were detected.
The operation was planned with the patient considering paraganglioma based on these results. Carvedilol (12.5 mg, 1 × 1, p.o.) treatment was started for the patient to control hypertension by following cardiology recommendations. Following 1 week of antihypertensive treatment, preoperative preparations were completed and the patient was excised with video-assisted thoracoscopic surgery (VATS) and excision was performed. During the operation, esmolol i.v. solution was available for hypertension and tachycardia, but hypertension and tachycardia were not observed. For the resection, 1 cm incisions were opened on the 4th and 7th intercostal spaces (ICS) anterior axillary line and 8th ICS posterior axillary line. The mass was dissected from the surrounding tissues using endo-cautery. The main artery of the mass was 1 mm in...


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