Korean J Leg Med.  2012 Nov;36(2):190-193. 10.7580/KoreanJLegMed.2012.36.2.190.

Sudden Death from an Non-diagnosed Paraganglioma after Surgery: A Case Report

• Choi M
• Park JH
• Kim HJ
• Choi BH
• Choi YS

• KMID: 2305481
• DOI: http://doi.org/10.7580/KoreanJLegMed.2012.36.2.190

Abstract

Extra-adrenal paragangliomas and pheochromocytomas are rare but clinically important tumors, which produce, store, release, and metabolize catecholamines resulting in unexpected life-threatening effects. It is neither easy nor difficult to clinically diagnose these tumors despite the availability modern clinical methods because signs and symptoms such as recurrent episodes of paroxysmal hypertension and headache are nonspecific. Only a few cases of unexpected death in which the deceased had a non-diagnosed paraganglioma or pheochromocytoma have been reported. Death in these cases is usually sudden and occurs during emergency room care or during a major or minor abdominal operation, without prodromal symptoms. Death is considered to occur because of paroxysmal hypertension, cerebrovascular attacks, abrupt hemorrhage into the tumor parenchyma, or acute left ventricular failure. We report the case of a 73-year-old man who died 12 hours after undergoing decompression surgery for spinal stenosis. A medico-legal autopsy revealed that death in this case resulted from an undiagnosed paraganglioma around the abdominal aorta.

Keyword

unexpected sudden death; spinal stenosis; decompression surgery; undiagnosed paraganglioma

MeSH Terms

Aged
Aorta, Abdominal
Autopsy
Catecholamines
Death, Sudden
Decompression
Emergencies
Headache
Hemorrhage
Humans
Hypertension
Paraganglioma
Paraganglioma, Extra-Adrenal
Pheochromocytoma
Prodromal Symptoms
Spinal Stenosis
Catecholamines

Figure

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  Fig. 1 The oval shaped mass is seen around the abdominal aorta.

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  Fig. 2 The mass is supplied via a small blood vessel from the aorta.

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  Fig. 3 The cut section shows yellow to white solid consistency with cystic and hemorrhagic change.

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  Fig. 4 The microscopic findings show characteristically arranged in well-defined nests (Zellballen) bound by a delicate fibrovascular stroma, and the tumor cells vary in size and shape and have a finely granular basophilic or amphophilic cytoplasm.

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  Fig. 5 The electron microscopic finding shows abundant cytoplasm with many small round dense-core granules.

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