대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Primary pulmonary paraganglioma

Radiologic Findings

Chest CT scan shows an about 1.7cm sized well-defined, oval-shaped subpleural nodule with homogeneous density (Fig.1-3). After contrast administration, the lesion shows mild to moderate enhancement (Fig.4-5). On follow-up CT taken eight months later, the size of the nodule had increased to 2.5 cm (Fig.6). CT evaluation of the neck and abdomen demonstrated no abnormal findings.VATS LULobectomy was performed. This mass was intrapulmonary lesion and abutted the visceral pleura. Histologic specimen shows prominent vascular spaces throughout the tumor, separating the islands of uniform tumor cells (Zellballen). Tumor cells show no mitosis or vascular invasion (Fig. 7).Immunohistochemistry for S100 was positive.

Brief Review

Primary pulmonary paragangliomas are extremely rare (< 1%). The thoracic manifestations of paragangliomas are mostly well-enhancing mediastinal masses, and others include metastatic parenchymal nodules, lymphadenopathy from malignant paragangliomas, and pulmonary edema as a complication of epinephrine-producing paragangliomas. The much less common manifestations include a primary mass in the lung, heart, esophagus and/or trachea. The patients are usually female and in their middle age. Most patients are free of symptoms and the tumors are often discovered incidentally on routine chest radiographs. They appear soft tissue attenuation on CT and typically show extensive enhancement after contrast administration.

References

Kim KN et al. Korean J Radiol. 2008 Jan-Feb; 9(1): 87–90.
JJ ZHANG et al. The Journal of International Medical Research 2012; 40: 1617 – 1626.
Imaging of the Chest.

Keywords

Lung, Benign tumor,