Obstet Gynecol Sci.  2018 Jul;61(4):520-523. 10.5468/ogs.2018.61.4.520.

Extra-adrenal paraganglioma masquerading as severe preeclampsia

• Kim HJ
• Yang SH
• Yang SH
• Han SS
• Kim GJ

• KMID: 2439726
• DOI: http://doi.org/10.5468/ogs.2018.61.4.520

Abstract

Paraganglioma in pregnancy is an extremely rare condition and its diagnosis is often delayed because the clinical symptoms can mimic those of preeclampsia or gestational hypertension. Here, we report the case of a 32-year-old, gravida 2, para 1 woman who presented with severe headache, palpitation, and sweating at 37 weeks' gestation. Although emergent cesarean section was performed on the assumption of severe preeclampsia, blood pressure fluctuated and heart rate remained tachycardiac. We suspected that she might have thromboembolic lesion in the chest or pheochromocytoma. Chest and abdominal computed tomography revealed a 4 cm mass in the left para-aortic space. Serum and urinary catecholamine levels were found to be significantly increased. She underwent laparoscopic mass removal and the pathology confirmed paraganglioma. When typical paroxysmal hypertension is accompanied by headache, palpitation, and sweating during pregnancy, adrenal tumors should be considered.

Keyword

Paraganglioma; Hypertension; Preeclampsia; Pregnancy

MeSH Terms

Adult
Blood Pressure
Cesarean Section
Diagnosis
Female
Headache
Heart Rate
Humans
Hypertension
Hypertension, Pregnancy-Induced
Paraganglioma
Paraganglioma, Extra-Adrenal*
Pathology
Pheochromocytoma
Pre-Eclampsia*
Pregnancy
Sweat
Sweating
Thorax

Figure

• 

  Fig. 1 An abdominopelvic computed tomography image showed 3.34×4.16×3.87 cm3 sized heterogeneous enhancing mass (arrow) in the left para-aortic space.

• 

  Fig. 2 (A) The tumor cells were characteristically arranged in well-defined nests (‘Zellballen’) bound by a delicate fibrovascular stroma (hematoxylin and eosin, ×200). (B) Immunohistochemical staining revealed a diffuse, strongly positive reaction for chromogranin A (immunostain, ×200).

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