# An unexpected retroperitoneal paraganglioma with hypertensive crisis during surgical resection: a case report and literature review

## TL;DR

A rare retroperitoneal tumor caused severe blood pressure spikes during surgery, leading to a correct diagnosis after careful monitoring and treatment.

## Contribution

Highlights the importance of considering paraganglioma in unexplained masses with intraoperative blood pressure fluctuations.

## Key findings

- A retroperitoneal paraganglioma was diagnosed after causing hypertensive crisis during surgery.
- Phentolamine infusion helped manage blood pressure during tumor removal.
- Postoperative histopathology confirmed the diagnosis and the patient recovered well.

## Abstract

Retroperitoneal paraganglioma is an extremely rare tumor. Its atypical clinical presentations often lead to missed and misdiagnosis. Here, we report a 60-year-old male with unexplained weight loss and a medical history of hypertension and diabetes. Preoperative evaluations showed a left lower abdominal mass, considered as a malignant gastrointestinal stromal tumor or a leiomyosarcoma. During the laparoscopic resection of tumor, his blood pressure fluctuated significantly, especially with the tumor manipulation that caused hypertensive crisis. Phentolamine infusion was given to control the blood pressure, and the tumor was removed under the open abdominal surgery. Further laboratory tests on catecholamine levels and postoperative histopathology confirmed the diagnosis of retroperitoneal paraganglioma. Follow-up showed good recovery with no complications. Paraganglioma should be considered when an unknown mass with severe blood pressure fluctuations is encountered during surgery. Careful preoperative preparations and close intraoperative monitoring should be applied in patients with suspected paraganglioma.