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Case Report
A 36-year old female patient was admitted to our hospital in October 2005, with symptoms of cough and phlegmatic stagnation plus chest distress for over 5 months. She had received an X-ray examination at a local hospital before her hospitalization, and it was shown that there was a small round-like pulmonary focus. No improvement was found after a pre-antiinflammatory treatment for the cough. CT scans showed that there were extensive nodular foci in both lungs, most of which were found in the inferior lungs. A shadow with multiple nodi could be seen in the mediastinum, with a likely possibility of metastatic lung carcinoma. A CT-guided right-lung puncture biopsy was conducted with the pathologic evidence revealing some tumor tissue (Fig.1). Immunohistochemical results indicated that homomorphic adenocarcinomas markers of the lung and kidney were expressed in the tumor cells, however, there was a strong expression of CgA, a neuroendocrine marker. The diagnosis was a pulmonary paraganglioma. One course of Taxotere chemotherapy with 120 mg d 1+cisplatin 100 mg d 2~4 was applied, and at the same time, Weimaining and thymopentin were administered plus symptomatic treatment of the cough. The patient was discharged form the hospital with improvement of her cough, without further follow-up.
CT image of the patient on admission.
Discussion
Paraganglioma is a rare soft-tissue neuroendocrine tumor, which belongs to the apudomas (amine precursor uptake and decarboxylation, APUD). Apudomas can be traced to neural-crest cells[1], and are divided into two kinds, i.e., a functional and nonfunctional. A chemodectoma is a nonfunctional paraganglioma, which has close anatomical correlation with the vascular structure[2]. It is most commonly seen in the carotid body and carotid gland body, and also is found in the retroperitoneal area, aortic body and vagal body. The tumor of this patient occurred in a site of the lungs, which is rare.
In 1958, Heppleston reported the first case of pulmonary chemodectoma, and related reports followed thereafter. At present 30 cases have been retrieved and aggregate analysis conducted. Based on past data, there are no obvious sex differences regarding the morbidity of this disease, and most cases occur in adults. The invasion site of this disease can mostly be seen at the bottom-left, the bottom-right and top-right lobes of the lungs, and those with a multiple space-occupying lesion have a common site at both inferior lobes of the lungs. A solitary nodus usually occurs as a benign tumor, without or with minor conspicuous clinical manifestations, whereas multiple nodi are most commonly found in a malignant form which is associated with frequent lymphatic metastasis at the hilum of the lungs and mediastinum, and manifests with different symptoms.
Concerning the treatment methods, direct excision should be conducted for those with a benign tumor or a resectable malignancy, and the patients with no surgical opportunity may receive arterial embolism, chemotherapy or radiotherapy, accompanied with a symptomatic treatment. Our patient received chemotherapy plus symptomatic treatments, achieving satisfactory therapy.
- Received June 22, 2007.
- Accepted August 15, 2007.
- Copyright © 2007 by Tianjin Medical University Cancer Institute & Hospital and Springer
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