Paraganglioma in an Unusual Location

A 36-year-old female was evaluated for pelvic pain of 6 months duration. She presented to our clinic with the MRI report suggestive of a well-defined, solid, T1 heterogeneously hypointense and T2 heterogeneously hyperintense lesion displaying post-contrast enhancement, central non-enhancing cystic areas, and areas displaying diffusion restriction, measuring 5.1 x 5.0 x 5.7 cm (APXTRXCC), noted in the mid pelvis at the level of the L5 vertebral body and the L5-S1 intervertebral disc. (Fig 1.). Black arrow pointing to the tumor. The lesion was noted closely abutting the bilateral iliac vessels posterolaterally. Anteriorly the lesion was noted abutting small bowel loops. Functional paraganglioma was ruled out by testing plasma-free metanephrines and 24-hour urine vanillylmandelic acid levels. CT scans of the head, neck, chest, and abdomen were performed to exclude the possibility of neural crest tumors in other sites. She underwent laparoscopic transperitoneal soft tissue tumor excision.When abdominal paragangliomas are possibly resectable, surgical excision is the preferred course of treatment; typically, this is done through an open procedure. The laparoscopic approach has been reported to be difficult for retroperitoneal paragangliomas due to the difficulty of handling a large tumor with forceps, extreme vascularization, and demanding localization despite the recent trend towards minimally invasive surgery. ⁷