PMC9280297_01
Echocardiography of cardiac paraganglioma. An enlarged left atrium and a hypoechoic mass of about 4.6 cm x 4.6 cm at the top of the right atrium near the superior vena cava was found with clear borders and uniform internal echogenicity, as well as the compression of the right atrium and the superior vena cava.
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F1
Compression of the right atrium and superior vena cava is demonstrated in Figure 1.
Computed tomography images of cardiac paraganglioma. (A) Plain image; (B) arterial phase image; (C) venous phase image.
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F2
Its blood was supplied by the left circumflex branch of the coronary artery with a nutrient vessel visible in the lesion and a draining vein connected to the superior vena cava (Figure 2).
Cardiac magnetic resonance images of cardiac paraganglioma. (A) T1-weighted image; (B) T2 fat-suppressed image; (C) diffusion-weighted imaging; (D) apparent diffusion coefficient image; (E) first-perfused image; (F) delayed scans image.
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F3
Heterogeneous and significant enhancement was shown in the first-perfused and delayed phases after intravenous contrast injection (Figure 3).
18F-FDG PET/CT images of cardiac paraganglioma. (A,B) The whole-body maximum intensity projection showed an intensely hypermetabolic thoracic mass. (C-E) In a cardiac lesion with a high FDG uptake, the SUVmax is about 15.2. (F-H) In the upper lobe of the right lung, a mixed-density nodule with a mild FDG-avid was found near the pleural, with the SUVmax at about 5.8 and a size of about 1.7 cm x 2.3 cm, inflammatory lesions were considered. (I-K) High FDG uptake of brown fat was demonstrated symmetrically along the perirenal and retroperitoneal area with the SUVmax at about 34.4, which was usually caused by the high secretion of catecholamine hormones from paragangliomas.
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F4
Furthermore, high FDG uptake of brown fat was demonstrated symmetrically along the bilateral intermuscular neck, posterior cervical triangle, mediastinum, intrapericardial, sternum, spine, parasternal, perirenal, and retroperitoneal area with the SUVmax at about 34.4, which were typically related with the high secretion of catecholamine hormones from paragangliomas (Figure 4).
Histologic and immunohistochemical features of cardiac paraganglioma. (A) Hematoxylin-eosin (HE) staining showed that the tumor cells were polygonal, with round-like nuclei and rare nuclear fission images (magnification, x200). In immunohistochemical staining, the tumor cells were positive for CD56 (B), SYN (C), CgA (D), and S-100 (E). Moreover, 3% of them were positive for Ki-67 (F) [magnification (B-F) x200].
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F5
Based on the results of pathological morphology and immunohistochemistry, the tumor was diagnosed as CPGL (Figure 5).