Notice bibliographique
Résumé
Background: Paraganglioma is a tumor derived from extra-adrenal chromaffin cells of the sympathetic paravertebral ganglia of thorax, abdomen, and pelvis. Malignancy is defined as the presence of metastases in nonchromaffin tissue (1). We discuss a case of metastatic paraganglioma for unusual course of disease and multiple challenges that arose in the management. Case presentation: 51-year-old female with mosaic turner presented to emergency with nausea, vomiting and abdominal pain. She had recent history of episodic high blood pressure and newly diagnosed diabetes mellitus. An abdominal CT scan which was done to assess abdominal pain revealed a retroperitoneal mass suspicious for paraganglioma. Subsequent blood work showed high plasma normetanephrine (x7 upper limit of normal). She underwent surgical resection of intra abdominal mass after blood pressure control with adequate alfa blockade treatment. Surgical pathology result confirmed the diagnosis of paraganglioma and showed high Ki-67 level and mitoses count. Three months post surgery, she developed severe blood pressure difficult to control; and her blood work revealed high plasma and urine normetanephrine suggestive of paraganglioma recurrence. The pre-op imaging including CT chest and abdomen were negative for any evidence of malignancy. However, repeat imaging three months post surgery showed multiple bone lesion in the skull, sternum, spine, and pelvic suggestive of metastatic disease. One week after the diagnosis of metastatic disease, she developed acute onset right eye proptosis due to retro-orbital mass which was resected. Surgical pathology was positive for metastatic paraganglioma. To determine extent of the disease and therapeutic choice, an octreotide scan was done which showed mild octreotide uptake in bone lesions. Therefore, peptide receptor radionucleotide radiation treatment (PRRT) was not considered for her metastatic disease treatment. In consultation with medical oncology, systemic chemotherapy was suggested, but it was also declined given her poor functional status. Eventually, she was started on targeted molecular therapy with sunitinib with good tolerance and response. We report this patient, first for the unusual course of disease given progression of metastatic disease over three months after surgical resection; second for the challenging therapeutic decision given the patient and disease unique characteristics. Conclusion: This case demonstrates an aggressive course of metastatic paraganglioma disease over a short period of time following surgical resection of primary tumor mass which shows the importance of earlier follow up post surgical resection of paraganglioma. This case might also justify broader work up such as MIBG or octreotide scan to determine the extent of disease and plan for the best therapeutic approach in certain cases prior to surgery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».