Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge
Incidental adrenal masses are frequently detected due to the extensive use of cross-sectional imaging, with about 3% to 7% of adults estimated to have them. Paragangliomas and pheochromocytomas (PPGL), rare tumors originating from paraganglia tissues, including the adrenal medulla, continue to be im...
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Elsevier
2025-03-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043324013426 |
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| author | Manali Bhatta Sharma Paudel Ongden Yonjen Tamang Prajwal Dahal Santosh Shrestha Sabina Parajuli |
| author_facet | Manali Bhatta Sharma Paudel Ongden Yonjen Tamang Prajwal Dahal Santosh Shrestha Sabina Parajuli |
| author_sort | Manali Bhatta |
| collection | DOAJ |
| description | Incidental adrenal masses are frequently detected due to the extensive use of cross-sectional imaging, with about 3% to 7% of adults estimated to have them. Paragangliomas and pheochromocytomas (PPGL), rare tumors originating from paraganglia tissues, including the adrenal medulla, continue to be imaging mimics, necessitating a multimodal approach for accurate diagnosis. We report a case of 72-years male presenting with intermittent pain abdomen for the past 1 year. Preliminary imaging by ultrasound revealed a suspicious gall bladder polypoidal lesion along with choledochal cyst for which further characterization was done with both CT and MRI. On imaging besides defining the findings seen in USG, we encountered a large heterogeneously enhancing possible left adrenal incidentaloma. A homogeneously hyper enhancing lesion along the paraganglia distribution, with no evidence of washout and a high T2 signal, is a hallmark imaging characteristic of pheochromocytomas and paragangliomas. However, around 35% of atypical lesions, often altered by degenerative changes, deviate from these typical imaging patterns, presenting a diagnostic dilemma. Histopathological analysis, including immunohistochemistry, biochemical testing, and functional imaging, can offer valuable insights to help diagnose and aid in predicting prognosis. |
| format | Article |
| id | doaj-art-0d0f725a05504fef9c906f702acbe81f |
| institution | Kabale University |
| issn | 1930-0433 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj-art-0d0f725a05504fef9c906f702acbe81f2025-01-18T05:03:59ZengElsevierRadiology Case Reports1930-04332025-03-0120315041511Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challengeManali Bhatta0Sharma Paudel1Ongden Yonjen Tamang2Prajwal Dahal3Santosh Shrestha4Sabina Parajuli5Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal; Corresponding author.Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Grande International Hospital, Kathmandu, NepalDepartment of Radiology and Imaging, Grande International Hospital, Kathmandu, NepalDepartment of Radiology and Imaging, Grande International Hospital, Kathmandu, NepalDepartment of General Surgery, Grande International Hospital, Kathmandu, NepalDepartment of Pathology, Bir Hospital, Kathmandu, NepalIncidental adrenal masses are frequently detected due to the extensive use of cross-sectional imaging, with about 3% to 7% of adults estimated to have them. Paragangliomas and pheochromocytomas (PPGL), rare tumors originating from paraganglia tissues, including the adrenal medulla, continue to be imaging mimics, necessitating a multimodal approach for accurate diagnosis. We report a case of 72-years male presenting with intermittent pain abdomen for the past 1 year. Preliminary imaging by ultrasound revealed a suspicious gall bladder polypoidal lesion along with choledochal cyst for which further characterization was done with both CT and MRI. On imaging besides defining the findings seen in USG, we encountered a large heterogeneously enhancing possible left adrenal incidentaloma. A homogeneously hyper enhancing lesion along the paraganglia distribution, with no evidence of washout and a high T2 signal, is a hallmark imaging characteristic of pheochromocytomas and paragangliomas. However, around 35% of atypical lesions, often altered by degenerative changes, deviate from these typical imaging patterns, presenting a diagnostic dilemma. Histopathological analysis, including immunohistochemistry, biochemical testing, and functional imaging, can offer valuable insights to help diagnose and aid in predicting prognosis.http://www.sciencedirect.com/science/article/pii/S1930043324013426Adrenal medullaGall bladderIncidentalomaParagangliomasPheochromocytomas |
| spellingShingle | Manali Bhatta Sharma Paudel Ongden Yonjen Tamang Prajwal Dahal Santosh Shrestha Sabina Parajuli Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge Radiology Case Reports Adrenal medulla Gall bladder Incidentaloma Paragangliomas Pheochromocytomas |
| title | Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge |
| title_full | Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge |
| title_fullStr | Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge |
| title_full_unstemmed | Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge |
| title_short | Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge |
| title_sort | incidental left paraaortic mass in a patient with gall bladder adenocarcinoma a diagnostic challenge |
| topic | Adrenal medulla Gall bladder Incidentaloma Paragangliomas Pheochromocytomas |
| url | http://www.sciencedirect.com/science/article/pii/S1930043324013426 |
| work_keys_str_mv | AT manalibhatta incidentalleftparaaorticmassinapatientwithgallbladderadenocarcinomaadiagnosticchallenge AT sharmapaudel incidentalleftparaaorticmassinapatientwithgallbladderadenocarcinomaadiagnosticchallenge AT ongdenyonjentamang incidentalleftparaaorticmassinapatientwithgallbladderadenocarcinomaadiagnosticchallenge AT prajwaldahal incidentalleftparaaorticmassinapatientwithgallbladderadenocarcinomaadiagnosticchallenge AT santoshshrestha incidentalleftparaaorticmassinapatientwithgallbladderadenocarcinomaadiagnosticchallenge AT sabinaparajuli incidentalleftparaaorticmassinapatientwithgallbladderadenocarcinomaadiagnosticchallenge |