The Giant Paraganglioma of The Sigmoid Mesentery：A Case Report

Background: PGL is originated from pheochromaffin cells in the adrenal paravertebral ganglion and often presented as a slow-growing, painless mass in the clinical, so many PGL are detected by imaging during physical examination. At present, surgery is still the primary treatment for radical treatment of PGL. However, If the disease and medical history cannot be asked in detail before surgery or imaging examination and related tests cannot be finished for diagnosis, the preoperative preparation will be insufficient and increasing the risk of surgery. Here, we reports the treatment of a case with undiagnosed giant sigmoid mesangial PGL before operation. Case presentation: The 56-year-old male patient was admitted to the hospital with "intermittent headache and dizziness for 3 years and aggravation for 1 week". Abdominal and pelvic CT showed that round soft tissue density shadow could be seen beside the left iliac artery in the pelvic cavity. The laparoscopic surgery was performed. The patient's blood pressure increased rapidly when the mass was removed intraoperatively, and decreased sharply when it was removed. Postoperative pathological examination showed that is a PGL. Conclusion: For patients diagnosed as space-occupying lesions accompanied by long-term persistent or intermittent hypertension, careful differentiation and diagnosis should be made in combination with the history and relevant examinations to reduce the misdiagnosis rate of the PGL. Meanwhile, the adequate preoperative preparation, intraoperative anesthesia monitoring and postoperative symptomatic supportive treatment should be done to reduce the risk of surgical treatment of this disease in the perioperative period.