Multimodal approach in radioguided surgery in a case of multiple paraganglioma

Publication date: Available online 26 May 2017
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): N. Sánchez, A. Tapias, H. Bowles, E. Delgado, R. Almenara, D. Fuster, S. Vidal-Sicart
The case involves a 34-year-old who underwent surgical removal of a retroperitoneal paraganglioma adjacent to the left kidney lower pole, and visualized by CT and MRI.The ¹²³I-MIBG scan was positive for this lesion and, in addition, another more caudal uptake, of smaller size and intensity, was observed at L5 level. It was not considered for removal, due to its lack of morphological definition.One week after the surgery, the patient presented with difficult-to-control high blood pressure.A second ¹²³I-MIBG scan was performed. The previously described second image was more intense, and surgery was planned to remove it.A combination of techniques including Freehand-SPECT and a portable hybrid gamma camera (with optical camera) were used pre-operatively to identify the location of the lesion. The combination of intra-operative laparoscopic gamma probe and portable hybrid gamma camera enabled the tumor to be located, excised, and its complete removal to be assessed. The histopathology analysis confirmed a second paraganglioma.



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