PARAGANGLIOMA OF THE FILUM TERMINALE EXTERNUM AND CONCURRENT ARTERIAL HYPERTENSION: A CASE REPORT

Paragangliomas are extra-adrenal counterparts of pheochromocytomas and are found at various anatomical sites such as the retroperitoneum, mediastinum, jugular foramen and carotid bifurcation, the latter two fonns being coined as chemodectomas. The vertebral column, especially the llUllbar zone, is one of the rarest sites to be involved by paragangliomas. These lesions may have secretory functions and produce symptoms and signs mimicking cathecholamine oversecretion as was noticed in our case. A 60-year-old woman with a sacral mass, backache, and cauda equina syndrome along with arterial hypertension is being presented who had been managed with antihypertensive medications. Magnetic resonance imaging revealed involvement of sacral canal and L5 and S 1 bodies producing a soft tissue bulge near the right buttock and computed tomography showed a destructive sacral lesion. Surgery was performed to resect the turnor mass and surprisingly the postoperative blood pressure reached the normal range and henceforth antihypertensive therapy was withheld. Tissue diagnosis of paraganglioma was made on the basis of histopathological examination and ascertained by immunohistochemical study for chromogranin, neuron specific enolase, synaptophysin and S 1 00 protein. One month later the tumor site was subjected to radiation for any remnants following surgery. After two years, the patient was found to be doing well and had been normotensive Without medications. Spinal paragangliomas are treated with total excision and irradiation for residual tumor, if present. The role of immunohistochemistry could not be overemphasized for diagnostic confirmation.