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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Multimodal approach in radioguided surgery in a case of multiple paraganglioma
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Vol. 37. Issue 1.
Pages 41-45 (January - February 2018)
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Vol. 37. Issue 1.
Pages 41-45 (January - February 2018)
Clinical note
Multimodal approach in radioguided surgery in a case of multiple paraganglioma
Abordaje multimodal en la cirugía radioguiada de un caso de paraganglioma múltiple
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N. Sáncheza,
Corresponding author
nusanchez@clinic.ub.es

Corresponding author.
, A. Tapiasa, H. Bowlesa, E. Delgadob, R. Almenarab, D. Fustera, S. Vidal-Sicarta
a Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
b Gastrointestinal Surgery Department, Hospital Clínic, Barcelona, Spain
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Abstract

The case involves a 34-year-old who underwent surgical removal of a retroperitoneal paraganglioma adjacent to the left kidney lower pole, and visualized by CT and MRI.

The 123I-MIBG scan was positive for this lesion and, in addition, another more caudal uptake, of smaller size and intensity, was observed at L5 level. It was not considered for removal, due to its lack of morphological definition.

One week after the surgery, the patient presented with difficult-to-control high blood pressure.

A second 123I-MIBG scan was performed. The previously described second image was more intense, and surgery was planned to remove it.

A combination of techniques including Freehand-SPECT and a portable hybrid gamma camera (with optical camera) were used pre-operatively to identify the location of the lesion. The combination of intra-operative laparoscopic gamma probe and portable hybrid gamma camera enabled the tumor to be located, excised, and its complete removal to be assessed. The histopathology analysis confirmed a second paraganglioma.

Keywords:
Freehand-Spect
Portable gamma camera
Paraganglioma
123I-MIBG
Radio-guided surgery
Resumen

Mujer de 34 años intervenida quirúrgicamente de un paraganglioma retroperitoneal adyacente al polo inferior del riñón izquierdo, visualizado por TC y RM.

La gammagrafía con 123I-MIBG fue positiva y además se evidenció otra captación de menor intensidad, prevertebral-L5, no subsidiaria de extirpación debido a la ausencia de traducción radiológica.

Una semana después de la cirugía, la paciente presentó HTA de difícil control.

Se realizó un segundo estudio con 123I-MIBG. La imagen sin traducción radiológica previa mostró mayor captación gammagráfica y fue localizada en las imágenes morfológicas, por lo que se reintervino la paciente.

Se utilizó una combinación de técnicas, incluyendo Freehand-SPECT y una gammacámara portátil-híbrida (con cámara óptica) para identificar la localización de la lesión, consiguiendo una buena planificación preoperatoria. La combinación de sonda gamma laparoscópica y gammacámara portátil-híbrida permitió la localización intraoperatoria del tumor y la evaluación de su completa extirpación. El análisis anatomopatológico confirmó un segundo paraganglioma.

Palabras clave:
Freehand-Spect
Gammacámara portátil
Paraganglioma
123I-MIBG
Cirugía radioguiada

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