Giant retroperitoneal paraganglioma: Challenges of misdiagnosis and high surgical risks, a case report.
Abstract
In surgery, misdiagnosis is not uncommon, usually a result of erroneous image interpretations and pathology diagnosis especially involving a tumor or cancer. Misdiagnosis may cause increased morbidity, mortality and surgical risks. A 49-year-old man presented for the second time with a right upper abdominal mass of 7 months. Previous CT scan of abdomen and exploratory surgery made the diagnosis of liver cancer. Two other tertiary hospitals drew the similar conclusions. At a cancer hospital the needle biopsy was suspicious for gastrointestinal stromal tumor, Imatinib was recommended but not started due to high cost. During this re-admission, the diagnosis of liver cancer or GIST was challenged. A high risk surgery was done with successive removal of a giant tumor. A final diagnosis of paraganlioma was made and the patient is now tumor free for 6 years. There are 4 lessons from this case. First, a paraganlioma may be misdiagnosed. Second, the misdiagnosis may be misled by CT scan and pathology. Third, a misdiagnosis can cause increased morbidity, mortality and surgical risks. Forth, massive intraoperative hemorrhage is a high risk of surgery. Careful clinical evaluation combined with pathology diagnosis may reduce the misdiagnosi...Continue Reading
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