A Multimodal Therapeutic Approach To Functional Paragangliom
Tumors arising from neural crest derivatives are generally found in the adrenal medulla, and commonly known as pheochromocytomas [1]. Those tumors that arise in extraadrenal locations are uncommon and known as paragangliomas [1,2]. Mediastinal paragangliomas are typically nonfunctional tumors [2]. However, functional paragangliomas are also uncommon and actively produce vasoactive amines [2]. Functional paragangliomas require a multidisciplinary therapeutic approach that includes appropriate control of hypertension, pre-operative embolization of the feeding arteries of the mass and surgical resection [2,3].

Case Report
A 32 year-old man was admitted to a state hospital with a complaint of left pleuritic pain. His past medical history was clear except for controllable hypertension, which was regulated with irbesartan combined with hydrochlorothiazide. His thoracic computerized tomography (CT) revealed a large left paravertebral soft tissue mass (80 x 76 x 56 mm) extending from the thoracic vertebrae T6 to T7 (Figure 1a). Mass view invading left half of T6 vertebral corpus and neural foramen at the left lung lower lobe was detected and a thoracic magnetic resonance imaging (MRI) was requested. Upon monitoring the paravertebral located mass at the posterior mediastinum in the thoracic MRI examination of the patient, he was referred to our hospital (Figure 1b). As high involvement (SUVmax: 24.1) was detected only in the mass in the positron emission computerized tomography (PET-CT) examination, a decision to conduct a tru-cut biopsy was made. The biopsy revealed the tumor to be neurogenic without a definitive histopathologic diagnosis....

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