# Spinal impostor: Metastatic cervical paraganglioma presenting with paraparesis, a case report

## TL;DR

A rare case of metastatic cervical paraganglioma presented as a spinal tumor, highlighting the difficulty in diagnosing such rare conditions.

## Contribution

This case report presents a rare instance of metastatic spinal paraganglioma without paraneoplastic symptoms.

## Key findings

- The tumor was initially misdiagnosed as Hodgkin's lymphoma based on imaging.
- Histopathology confirmed the tumor as a metastatic paraganglioma after multiple biopsies.
- Surgery was necessary for both diagnosis and treatment due to spinal cord compression.

## Abstract

Paragangliomas are rare neuroendocrine tumors, typically arising from extra-adrenal chromaffin cells. Primary intra-spinal paragangliomas are uncommon, and metastatic spinal paragangliomas without paraneoplastic symptoms are even rarer. This case highlights the diagnostic challenges posed by such rare tumors.

A 28-year-old male soldier from the Comoros Islands presented with a neck mass, initially suspected to be Hodgkin's lymphoma based on imaging. Biopsy of two cervical nodes revealed reactive lymphadenopathy. Later, he developed progressive lower limb weakness and numbness, prompting further investigation. Imaging showed an extradural spinal tumor at T6 with cord compression. Laminectomy and tumor excision relieved compression, revealing a highly vascularized tumor. Histopathology and immunohistochemistry confirmed a paraganglioma, which was consistent with the metastatic nature confirmed by a repeat biopsy of the neck mass.

Metastatic spinal paragangliomas are rare and challenging to diagnose, especially without paraneoplastic symptoms. This case underscores the importance of thorough histopathological evaluation when spinal lesions and neck masses present with unusual features and highlights the need for a multidisciplinary approach.

This case emphasizes the diagnostic difficulty of metastatic spinal paragangliomas, particularly when they mimic more common conditions like Hodgkin's lymphoma. It stresses the importance of considering rare differential diagnoses and a collaborative approach to managing such cases.

•Rare presentation: Cervical Paraganglioma with spine metastasis•Diagnostic challenge: Needing imaging and multiple biopsies for histopathological diagnosis•Management dilemma: Surgery was required for diagnosis and treatment due to spine metastasis and unclear malignancy

Rare presentation: Cervical Paraganglioma with spine metastasis

Diagnostic challenge: Needing imaging and multiple biopsies for histopathological diagnosis

Management dilemma: Surgery was required for diagnosis and treatment due to spine metastasis and unclear malignancy