Neurointervention.  2015 Feb;10(1):34-38. 10.5469/neuroint.2015.10.1.34.

Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

• Chacon-Quesada T
• Rodriguez
• Maud A
• Ramos-Duran L
• Torabi A
• Fitzgerald T
• Akle N
• Cruz Flores S
• Trier T

• KMID: 1910758
• DOI: http://doi.org/10.5469/neuroint.2015.10.1.34

Abstract

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma.

Keyword

Paraganglioma; Embolization; Onyx

MeSH Terms

Endocrine System
Humans
Paraganglioma*
Spinal Cord Compression
Spine
Young Adult

Figure

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  Fig. 1 Diagnostic imaging. A. Sagittal T2-weighted image demonstrating a pathologic T6 compression fracture and cord edema. B. Coronal STIR (upper) showing a paraspinal and intraspinal extradural heterogeneous enhancing mass extending from T4-T9 causing widening of the neural foramina and severe canal stenosis. There was a separate metastatic hyperintense lesion in L3 vertebral body (lower B). C. I-123 MIBG whole body AP view demonstrated intense uptake within the large right paravertebral mass and separate L3 lytic lesion.

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  Fig. 2 Digital Subtraction Angiography. A. Diagnostic angiogram in the anterior-posterior view shows a highly vascular tumor. Note the prominent tumor blush within the main feeders (T7-T9). B. Control angiogram after each ONYX embolization reveals complete devascularization with no residual tumor blush.

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  Fig. 3 Pathology. A. Nests of tumor cells (Zellballen) composed of uniform cells with round nuclei, eosinophil cytoplasm in a highly vascular stroma (Haematoxylin and Eosin, 40×). B. Inmmunohistochemical staining of the tumor showing positivity for Chromogranin (10×). C. A tumor measuring 10×7×3 cm resected in the second surgery. Microscopic examination of the resected mass evidence D) 50% coagulative necrosis of the tumor (black arrow) with the embolic material completely occluding an artery, and E) some viable tumor cells after the embolization (black arrows) (Haematoxylin and Eosin, 10×).

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