Tracheal Paraganglioma: A Case report and Review of the Pertinent Literature

Figures

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  Figure 1.. (a-c) Axial CT images showed a 1.8×1.4-cm mass arising from the left posterolateral tracheal wall. (b, c) Contrast-enhanced CT images showed marked homogeneous enhancement.

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  Figure 2.. The tumor demonstrated iso-intensity on T1-WI (a) and high intensity on T2-WI (b) and a very strong signal intensity on fat-suppressed T2-WI (c). The mass showed a high signal intensity on diffusion-weighted imaging (DWI) (inverse display) with a mean apparent diffusion coefficient (ADC) of 1.98×10-3 mm2/s (d, e). WI: weighted imaging

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  Figure 3.. (a-e) Dynamic contrast-enhanced MRI images showed marked enhancement with an intensity equal to that of the nearby vascular structures in each phase.

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  Figure 4.. 18F-fluorodeoxyglucose PET showed a high uptake of the tumor. The maximum standardized uptake value (SUVmax) was 7.2.

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  Figure 5.. Bronchoscopy showed a hemorrhagic tumor with hyper vascularization in the trachea.

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  Figure 6.. The medium-power photomicrograph (×100) showed cells with abundant pale cytoplasm and hyperchromatic nuclei. Vascular hyperplasia was relatively abundant (arrows) (a). In the medium-power photomicrograph (×100), AE1/AE3 was negative, and synaptophysin was strongly positive in tumor cells (b, c). In the medium-power photomicrograph (×100), S100 was strongly positive in sustentacular cells (d).

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  Figure 7.. (a-c) Axial CT images showed a 1.9×1.5-cm mass arising from the posterior tracheal wall. (b, c) Contrast-enhanced CT images showed a marked enhancement, equal attenuation to the nearby vascular structures in both the early and late phases. Axial (b) and sagittal (d) CT images in the early phase showed a heterogeneous mass with a relatively weak contrast area (arrows) in the center of the mass. (c) The CT image in the late phase showed homogeneity and a high degree of enhancement for the mass.

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  Figure 8.. (a) The MR signal was equal to that of the chest wall muscle on T1-WI. T2-WI (b, f) and fat-suppressed T2-WI (c) demonstrated a heterogeneous hyperintense mass. The center of the tumor showed a slightly higher signal (arrow) than the margin on T2-WI and fat-suppressed T2-WI. The mass showed a high signal intensity on diffusion-weighted imaging (DWI) with a mean apparent diffusion coefficient (ADC) of 2.25×10-3 mm2/s (d, e). WI: weighted imaging

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  Figure 9.. (a) A signal void was seen at the margin of the mass on T2-weighted imaging (arrow). (b) It was identified as a vessel by a contrast-enhanced study (arrow).

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  Figure 10.. (a) The loupe magnification (×5) cut in a cross section similar to the axial section of CT and MRI showed slightly large vessels at the margin of the tumor (black arrows) and a myxoid matrix in the center of the tumor (white arrows). (b) In the high-power photomicrograph (×200), the tumor cells had abundant pale cytoplasm and hyperchromatic nuclei. Vascular hyperplasia was relatively abundant, and spindle-shaped cells were also found in the tumor. (c, d) The medium-power photomicrograph (×50) showed slightly large vessels at the margin of the tumor (c) and myxoid matrix in the center of the tumor (d).