Endocrine Abstracts

Introduction: Paragangliomas (PGLs) are tumors originating from neural crest-derived cells situated in the region of the autonomic nervous system ganglia. Head-and-neck PGLs (HNPGLs) originate from the sympathetic and parasympathetic paraganglia, most frequently from the carotid bodies and jugular, tympanic and vagal paraganglia, and are usually non-catecholamine secreting.

Case report: We present the case of a 60 years old male patient, which was admitted at Endocrinology Department for differential diagnosis of bilateral cervical lymph nodes, which occurred over past 10 years, with a clinical exacerbation in the last year. His thyroid ultrasound results were suggestive only for a Hashimoto’s thyroiditis, with hormonal tests implying hypothyroid status. In the context of bilateral lymph nodes, with MRI that indicated a potential haemalogical malignancy, the left lateral cervical formation has been biopsied and the histopathological result concluded: head and neck paraganglioma. Immunohistochemical result indicates that our HNPGL might have malignancy potential: increased tumor dimensions (over 10 cm identified on MRI exam), Ki 67 positive in 3% of the tumor cells, sustentacular cells and low expression of S100 in those cells. Other immunohistochemical staining highlighted positive synaptophysin, chromogranin and GATA3. Our patient was not expressing catecholamine secretion clinical features but we recommend complete hormonal exploration: normetanephrine, 3-methoxytyramine and neuron-specific enolase (NSE), tests in working progress. We will recommend full exploration of adrenal glands also, to exclude synchronous affection.

Conclusion: His case will be reviewed by multidisciplinary committee to conclude proper therapeutic management: surgery, radiotherapy or somatostatin analogs and potential PRRT after specific functional imaging. With integral neuroendocrine tumor markers and functional imaging results we’ll be able to determine if this paraganglioma is malignant or not.