Robotic Paraganglioma Resection In A Pregnant Patient

Abstract

ABSTRACT: Objective: Functional paragangliomas in pregnancy are rare; however, if not recognized and treated early, they can be life-threatening. New treatment approaches with robotic resection are promising. Methods: We present a case of a pregnant female with a paraganglioma which was successfully resected during the second trimester using Da Vinci Xi robotic system. Paraganglioma was diagnosed with plasma and urinary catecholamines and metanephrines, a contrast computed tomography (CT) scan, and confirmed with surgical pathology. Results: The patient was initially seen in the emergency room prior to the index pregnancy for nausea, vomiting, and intermittent, left lower quadrant abdominal pain, episodic sweating, palpitations, and anxiety. CT scan of the abdomen and pelvis showed a 4.8 × 4.3 cm heterogeneously enhancing mass in the left retroperitoneum adjacent to the aorta just below the left adrenal gland. She had normal plasma metanephrines but elevated plasma normetanephrines of 7.12 nmol/L (normal, <0.89 nmol/L). Twenty-four-hour urine norepinephrine and catecholamines were elevated to 604 μg (normal, <90 μg/24 hours) and 610 μg (normal, <115 μg/24 hours), respectively. Chromogranin A was elevated to 940 ng/mL (normal, 0 to 95 ng/mL). Paraganglioma was suspected. Doxazosin was started for blood pressure control. The patient became pregnant unexpectedly shortly after. She was managed by a multidisciplinary team. At 18 weeks of pregnancy, she underwent a transabdominal robotic resection of the left retroperitoneal paraganglioma with an excellent outcome. Conclusion: Functional paragangliomas in pregnancy are rare but must be recognized and treated early to reduce maternal and fetal complications. An innovative robotic approach should be considered and explored. Abbreviation: PPGL pheochromocytoma and paraganglioma