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Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas.

Prajsnar A, Balak N, Walter GF, Stan AC, Deinsberger W, Tapul L, Bayindir C - Surg Neurol Int (2011)

Bottom Line: A lateral suboccipital approach to the lesion was used under neuronavigational guidance.Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention.Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Klinikum Kassel, Kassel, Germany.

ABSTRACT

Background: Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave.

Case description: A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention.

Conclusions: A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.

No MeSH data available.


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Transmission electron microscopy shows identification of neurosecretory granules (arrow) in chief cells. Higher magnification in the inset
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Figure 4: Transmission electron microscopy shows identification of neurosecretory granules (arrow) in chief cells. Higher magnification in the inset

Mentions: It was decided to confirm further the diagnosis of paraganglioma using an electron microscopic (EM) examination. For this purpose, a transmission electron microscopy study was carried out in specific areas of the formalin-fixed, paraffin-embedded blocks, using a modified protocol of previously described various methods.[123661] The areas that were rich in chief cells as identified by immunohistochemistry and light microscopy were marked on the surface of the paraffin-embedded blocks. In these marked areas, tissue fragments of 1 mm3 were cut with a sharp razor blade. Samples of 1 mm3 that were cut out were deparaffinized using toluene solution at room temperature for 90 minutes. The specimens were transferred to an absolute alcohol solution, and after a reprocessing protocol, the re-embedded epon blocks of the tissue pieces were sectioned and ultrathin sections of 400-600 Åf were obtained using an ultramicrotome (LKB Ultramicrotome, Stockholm, Sweden). Thick sections were stained with toluidine blue and examined. The ultrathin sections were contrasted with uranyl acetate and lead citrate. Finally, these ultrathin sections were analyzed and documented photographically using a transmission electron microscope (JEOL 100 C, Tokyo, Japan). The ultrathin sections permitted the identification of neurosecretory granules, which are the distinctive ultrastructural feature of chief cells and confirmed the diagnosis of paraganglioma in this case [Figure 4].


Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas.

Prajsnar A, Balak N, Walter GF, Stan AC, Deinsberger W, Tapul L, Bayindir C - Surg Neurol Int (2011)

Transmission electron microscopy shows identification of neurosecretory granules (arrow) in chief cells. Higher magnification in the inset
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108444&req=5

Figure 4: Transmission electron microscopy shows identification of neurosecretory granules (arrow) in chief cells. Higher magnification in the inset
Mentions: It was decided to confirm further the diagnosis of paraganglioma using an electron microscopic (EM) examination. For this purpose, a transmission electron microscopy study was carried out in specific areas of the formalin-fixed, paraffin-embedded blocks, using a modified protocol of previously described various methods.[123661] The areas that were rich in chief cells as identified by immunohistochemistry and light microscopy were marked on the surface of the paraffin-embedded blocks. In these marked areas, tissue fragments of 1 mm3 were cut with a sharp razor blade. Samples of 1 mm3 that were cut out were deparaffinized using toluene solution at room temperature for 90 minutes. The specimens were transferred to an absolute alcohol solution, and after a reprocessing protocol, the re-embedded epon blocks of the tissue pieces were sectioned and ultrathin sections of 400-600 Åf were obtained using an ultramicrotome (LKB Ultramicrotome, Stockholm, Sweden). Thick sections were stained with toluidine blue and examined. The ultrathin sections were contrasted with uranyl acetate and lead citrate. Finally, these ultrathin sections were analyzed and documented photographically using a transmission electron microscope (JEOL 100 C, Tokyo, Japan). The ultrathin sections permitted the identification of neurosecretory granules, which are the distinctive ultrastructural feature of chief cells and confirmed the diagnosis of paraganglioma in this case [Figure 4].

Bottom Line: A lateral suboccipital approach to the lesion was used under neuronavigational guidance.Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention.Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Klinikum Kassel, Kassel, Germany.

ABSTRACT

Background: Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave.

Case description: A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention.

Conclusions: A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.

No MeSH data available.


Related in: MedlinePlus