Primary extradural paraganglioma of the thoracic spine
A 34-year-old woman was admitted to the hospital after acute loss of motor and sensory function in lower extremities as well as urine and bowel incontinence. On admission, the patient was not hypertensive and had no apparent catecholamine-related symptoms. Thoracic MRI revealed a 5.7 cm extradural mass spanning from T6 to T8 with spinal canal stenosis and cord compression. Emergent T6-T8 decompressive laminectomy and tumor resection was performed. Pathological examination of the mass demonstrated positivity for synaptophysin, elevated chromogranin A, and indiscernible mitotic activity, confirming the diagnosis of a neuroendocrine tumor. Nine days post-operatively, an octreotide scan revealed residual neuroendocrine tumor with increased somatostatin receptors at the left T7 paravertebral region and midline T8-T9 level with no other masses suggestive of a separate primary origin. Subsequent radiation therapy was performed and the patient followed up with physical rehabilitation. An MRI performed four months post-operatively showed no recurrence at resection site and stable left paravertebral region residual lesion. Paragangliomas are uncommon. The exact prevalence is unknown, but it is estimated to be 0.2-1/100,000. Spinal paragangliomas are uncommon among paragangliomas and usually present as intradural tumors of the filum terminale and cauda equina. Thoracic spinal paragangliomas are rare spinal paragangliomas, with only 15 reported cases.