UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Paragangliomas: Treatment of locoregional disease

Authors
Sally E Carty, MD, FACS
William F Young, Jr, MD, MSc
Derrick Lin, MD
Kevin Oh, MD
Section Editors
Patrick Y Wen, MD
Jay S Loeffler, MD
André Lacroix, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, small organs that consist mainly of neuroendocrine (chromaffin) cells that are derived from the embryonic neural crest and have the ability to secrete catecholamines (figure 1). (See "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology", section on 'Catecholamine hypersecretion'.)

Paragangliomas are closely related to pheochromocytomas, which are sometimes referred to as intra-adrenal paragangliomas, and they are indistinguishable from pheochromocytomas at the cellular level. Catecholamine-secreting paragangliomas often present clinically like pheochromocytomas with hypertension, episodic headache, sweating, and tachycardia. However, the distinction between pheochromocytoma and paraganglioma is an important one because of implications for associated neoplasms, risk for malignancy, and genetic testing. (See "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology", section on 'Histology and malignant potential' and "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology", section on 'Indications for genetic testing'.)

Paragangliomas can derive from either parasympathetic or sympathetic paraganglia. They differ in their anatomic distribution, frequency of an underlying genetic syndrome, and clinical features (see "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology", section on 'Definition and anatomic origin'):

The majority of parasympathetic ganglia-derived paragangliomas are located in the neck and skull base along the branches of the glossopharyngeal and vagus nerves (figure 2). They arise most commonly from the carotid body, less commonly from jugulotympanic and vagal paraganglia, and rarely from the laryngeal paraganglia.

A minority of skull base paragangliomas (approximately 5 percent) are symptomatic from hypersecretion [1,2]. About one-half are associated with a disease-causing germline mutation. (See "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology", section on 'Hereditary syndromes' and "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology", section on 'Catecholamine hypersecretion'.)

                                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu May 12 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. van Duinen N, Steenvoorden D, Kema IP, et al. Increased urinary excretion of 3-methoxytyramine in patients with head and neck paragangliomas. J Clin Endocrinol Metab 2010; 95:209.
  2. McNicol AM. Update on tumours of the adrenal cortex, phaeochromocytoma and extra-adrenal paraganglioma. Histopathology 2011; 58:155.
  3. Erickson D, Kudva YC, Ebersold MJ, et al. Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab 2001; 86:5210.
  4. Lee JA, Duh QY. Sporadic paraganglioma. World J Surg 2008; 32:683.
  5. Tischler A. The adrenal medulla and extra-adrenal paraganglia. In: Functional Endocrine Pathology, Kovacs K, Asa S. (Eds), Oxford 1998. p.550.
  6. Pathology and Genetics of Tumours of the Endocrine Organs. WHO Classification of Tumours, DeLellis RA, Lloyd RV, Heitz PU, Eng C. (Eds), IARC press, Lyon, France 2004.
  7. Lee JH, Barich F, Karnell LH, et al. National Cancer Data Base report on malignant paragangliomas of the head and neck. Cancer 2002; 94:730.
  8. Manolidis S, Shohet JA, Jackson CG, Glasscock ME 3rd. Malignant glomus tumors. Laryngoscope 1999; 109:30.
  9. Sajid MS, Hamilton G, Baker DM, Joint Vascular Research Group. A multicenter review of carotid body tumour management. Eur J Vasc Endovasc Surg 2007; 34:127.
  10. Heinrich MC, Harris AE, Bell WR. Metastatic intravagal paraganglioma. Case report and review of the literature. Am J Med 1985; 78:1017.
  11. Morton RP, Stewart T, Dray MS, Farmilo W. A role for ipsilateral, selective neck dissection in carotid body tumours. J Laryngol Otol 2009; 123:934.
  12. Moskovic DJ, Smolarz JR, Stanley D, et al. Malignant head and neck paragangliomas: is there an optimal treatment strategy? Head Neck Oncol 2010; 2:23.
  13. Chen H, Sippel RS, O'Dorisio MS, et al. The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 2010; 39:775.
  14. van den Berg R, Wasser MN, van Gils AP, et al. Vascularization of head and neck paragangliomas: comparison of three MR angiographic techniques with digital subtraction angiography. AJNR Am J Neuroradiol 2000; 21:162.
  15. Hu K, Persky MS. Multidisciplinary management of paragangliomas of the head and neck, Part 1. Oncology (Williston Park) 2003; 17:983.
  16. Persky MS, Setton A, Niimi Y, et al. Combined endovascular and surgical treatment of head and neck paragangliomas--a team approach. Head Neck 2002; 24:423.
  17. Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:1915.
  18. Wang SJ, Wang MB, Barauskas TM, Calcaterra TC. Surgical management of carotid body tumors. Otolaryngol Head Neck Surg 2000; 123:202.
  19. Saringer W, Kitz K, Czerny C, et al. Paragangliomas of the temporal bone: results of different treatment modalities in 53 patients. Acta Neurochir (Wien) 2002; 144:1255.
  20. Power AH, Bower TC, Kasperbauer J, et al. Impact of preoperative embolization on outcomes of carotid body tumor resections. J Vasc Surg 2012; 56:979.
  21. Montaña E, Montañá X, Morera R, et al. Functioning paraganglioma (pheochromocytoma) of the thorax: preoperative embolization. J Thorac Cardiovasc Surg 1990; 100:626.
  22. Ali AM, Devbhandari M, Sastry A, et al. Preoperative embolization followed by surgical excision of an intrapericardial pheochromocytoma. Ann Thorac Surg 2007; 83:302.
  23. Karaman E, Isildak H, Yilmaz M, et al. Management of paragangliomas in otolaryngology practice: review of a 7-year experience. J Craniofac Surg 2009; 20:1294.
  24. Makiese O, Chibbaro S, Marsella M, et al. Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases. Neurosurg Rev 2012; 35:185.
  25. Boedeker CC. Paragangliomas and paraganglioma syndromes. GMS Curr Top Otorhinolaryngol-Head Neck Surg 2011; 10:Doc03.Full text article available online at http://www.egms.de/static/en/journals/cto/2012-10/cto000076.shtml (Accessed on October 26, 2012).
  26. Miller RB, Boon MS, Atkins JP, Lowry LD. Vagal paraganglioma: the Jefferson experience. Otolaryngol Head Neck Surg 2000; 122:482.
  27. LaMuraglia GM, Fabian RL, Brewster DC, et al. The current surgical management of carotid body paragangliomas. J Vasc Surg 1992; 15:1038.
  28. Tikkakoski T, Luotonen J, Leinonen S, et al. Preoperative embolization in the management of neck paragangliomas. Laryngoscope 1997; 107:821.
  29. Schick PM, Hieshima GB, White RA, et al. Arterial catheter embolization followed by surgery for large chemodectoma. Surgery 1980; 87:459.
  30. Tasar M, Yetiser S. Glomus tumors: therapeutic role of selective embolization. J Craniofac Surg 2004; 15:497.
  31. Zaki FM, Osman SS, Abdul Manaf Z, et al. The value of pre-operative embolisation in primary inferior vena cava paraganglioma. Malays J Med Sci 2011; 18:70.
  32. Rakovich G, Ferraro P, Therasse E, Duranceau A. Preoperative embolization in the management of a mediastinal paraganglioma. Ann Thorac Surg 2001; 72:601.
  33. Jackson RS, Myhill JA, Padhya TA, et al. The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2015; 153:943.
  34. Litle VR, Reilly LM, Ramos TK. Preoperative embolization of carotid body tumors: when is it appropriate? Ann Vasc Surg 1996; 10:464.
  35. Valavanis A. Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions. AJNR Am J Neuroradiol 1986; 7:943.
  36. Kafie FE, Freischlag JA. Carotid body tumors: the role of preoperative embolization. Ann Vasc Surg 2001; 15:237.
  37. Green JD Jr, Brackmann DE, Nguyen CD, et al. Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 1994; 104:917.
  38. Gstoettner W, Matula C, Hamzavi J, et al. Long-term results of different treatment modalities in 37 patients with glomus jugulare tumors. Eur Arch Otorhinolaryngol 1999; 256:351.
  39. Suárez C, Rodrigo JP, Bödeker CC, et al. Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy. Head Neck 2013; 35:1195.
  40. Huy PT, Kania R, Duet M, et al. Evolving concepts in the management of jugular paraganglioma: a comparison of radiotherapy and surgery in 88 cases. Skull Base 2009; 19:83.
  41. Hinerman RW, Amdur RJ, Morris CG, et al. Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience. Head Neck 2008; 30:1431.
  42. Chino JP, Sampson JH, Tucci DL, et al. Paraganglioma of the head and neck: long-term local control with radiotherapy. Am J Clin Oncol 2009; 32:304.
  43. Krych AJ, Foote RL, Brown PD, et al. Long-term results of irradiation for paraganglioma. Int J Radiat Oncol Biol Phys 2006; 65:1063.
  44. Lightowlers S, Benedict S, Jefferies SJ, et al. Excellent local control of paraganglioma in the head and neck with fractionated radiotherapy. Clin Oncol (R Coll Radiol) 2010; 22:382.
  45. Galland-Girodet S, Maire JP, De-Mones E, et al. The role of radiation therapy in the management of head and neck paragangliomas: impact of quality of life versus treatment response. Radiother Oncol 2014; 111:463.
  46. Dupin C, Lang P, Dessard-Diana B, et al. Treatment of head and neck paragangliomas with external beam radiation therapy. Int J Radiat Oncol Biol Phys 2014; 89:353.
  47. Noda E, Ishikawa T, Maeda K, et al. Laparoscopic resection of periadrenal paraganglioma: a report of 2 cases. Surg Laparosc Endosc Percutan Tech 2008; 18:310.
  48. Draaisma WA, van Hillegersberg R, Borel Rinkes IH, et al. Robot-assisted laparoscopic resection of a large paraganglioma: a case report. Surg Laparosc Endosc Percutan Tech 2006; 16:362.
  49. Tagaya N, Suzuki N, Furihata T, Kubota K. Laparoscopic resection of a functional paraganglioma in the organ of Zuckerkandl. Surg Endosc 2002; 16:219.
  50. Clements RH, Holzman MD, Blevins LS, et al. Endoscopic retroperitoneal resection of a para-aortic paraganglioma: report of a case and description of a technique. Surgery 1999; 126:977.
  51. Walz MK, Peitgen K, Neumann HP, et al. Endoscopic treatment of solitary, bilateral, multiple, and recurrent pheochromocytomas and paragangliomas. World J Surg 2002; 26:1005.
  52. Dubois LA, Gray DK. Dopamine-secreting pheochromocytomas: in search of a syndrome. World J Surg 2005; 29:909.
  53. Foo SH, Chan SP, Ananda V, Rajasingam V. Dopamine-secreting phaeochromocytomas and paragangliomas: clinical features and management. Singapore Med J 2010; 51:e89.
  54. Ponce FA, Killory BD, Wait SD, et al. Endoscopic resection of intrathoracic tumors: experience with and long-term results for 26 patients. J Neurosurg Spine 2011; 14:377.
  55. Han PP, Dickman CA. Thoracoscopic resection of thoracic neurogenic tumors. J Neurosurg 2002; 96:304.
  56. Ramlawi B, David EA, Kim MP, et al. Contemporary surgical management of cardiac paragangliomas. Ann Thorac Surg 2012; 93:1972.
  57. Gilbo P, Morris CG, Amdur RJ, et al. Radiotherapy for benign head and neck paragangliomas: a 45-year experience. Cancer 2014; 120:3738.
  58. Foote RL, Pollock BE, Gorman DA, et al. Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery. Head Neck 2002; 24:332.
  59. Henzel M, Hamm K, Gross MW, et al. Fractionated stereotactic radiotherapy of glomus jugulare tumors. Local control, toxicity, symptomatology, and quality of life. Strahlenther Onkol 2007; 183:557.
  60. Wegner RE, Rodriguez KD, Heron DE, et al. Linac-based stereotactic body radiation therapy for treatment of glomus jugulare tumors. Radiother Oncol 2010; 97:395.
  61. Guss ZD, Batra S, Limb CJ, et al. Radiosurgery of glomus jugulare tumors: a meta-analysis. Int J Radiat Oncol Biol Phys 2011; 81:e497.
  62. Jordan JA, Roland PS, McManus C, et al. Stereotastic radiosurgery for glomus jugulare tumors. Laryngoscope 2000; 110:35.
  63. Chen PG, Nguyen JH, Payne SC, et al. Treatment of glomus jugulare tumors with gamma knife radiosurgery. Laryngoscope 2010; 120:1856.
  64. Künzel J, Iro H, Hornung J, et al. Function-preserving therapy for jugulotympanic paragangliomas: a retrospective analysis from 2000 to 2010. Laryngoscope 2012; 122:1545.
  65. Kim JA, Elkon D, Lim ML, Constable WC. Optimum dose of radiotherapy for chemodectomas of the middle ear. Int J Radiat Oncol Biol Phys 1980; 6:815.
  66. Wang ML, Hussey DH, Doornbos JF, et al. Chemodectoma of the temporal bone: a comparison of surgical and radiotherapeutic results. Int J Radiat Oncol Biol Phys 1988; 14:643.
  67. Boyle JO, Shimm DS, Coulthard SW. Radiation therapy for paragangliomas of the temporal bone. Laryngoscope 1990; 100:896.
  68. Evenson LJ, Mendenhall WM, Parsons JT, Cassisi NJ. Radiotherapy in the management of chemodectomas of the carotid body and glomus vagale. Head Neck 1998; 20:609.
  69. Lieberson RE, Adler JR, Soltys SG, et al. Stereotactic radiosurgery as the primary treatment for new and recurrent paragangliomas: is open surgical resection still the treatment of choice? World Neurosurg 2012; 77:745.
  70. Eustacchio S, Leber K, Trummer M, et al. Gamma knife radiosurgery for glomus jugulare tumours. Acta Neurochir (Wien) 1999; 141:811.
  71. Feigenberg SJ, Mendenhall WM, Hinerman RW, et al. Radiosurgery for paraganglioma of the temporal bone. Head Neck 2002; 24:384.
  72. Pollock BE. Stereotactic radiosurgery in patients with glomus jugulare tumors. Neurosurg Focus 2004; 17:E10.
  73. Liscak R, Urgosik D, Chytka T, et al. Leksell Gamma Knife radiosurgery of the jugulotympanic glomus tumor: long-term results. J Neurosurg 2014; 121 Suppl:198.
  74. Pan CC, Eisbruch A, Lee JS, et al. Prospective study of inner ear radiation dose and hearing loss in head-and-neck cancer patients. Int J Radiat Oncol Biol Phys 2005; 61:1393.
  75. Narayan S, Lehmann J, Coleman MA, et al. Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head-and-neck conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72:756.
  76. Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys 2010; 37:4078.
  77. Beetz I, Steenbakkers RJ, Chouvalova O, et al. The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia. Acta Oncol 2014; 53:597.
  78. Papaspyrou K, Mann WJ, Amedee RG. Management of head and neck paragangliomas: review of 120 patients. Head Neck 2009; 31:381.
  79. Makeieff M, Raingeard I, Alric P, et al. Surgical management of carotid body tumors. Ann Surg Oncol 2008; 15:2180.
  80. Borba LA, Araújo JC, de Oliveira JG, et al. Surgical management of glomus jugulare tumors: a proposal for approach selection based on tumor relationships with the facial nerve. J Neurosurg 2010; 112:88.
  81. Fayad JN, Keles B, Brackmann DE. Jugular foramen tumors: clinical characteristics and treatment outcomes. Otol Neurotol 2010; 31:299.
  82. Jansen JC, van den Berg R, Kuiper A, et al. Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer 2000; 88:2811.
  83. Langerman A, Athavale SM, Rangarajan SV, et al. Natural history of cervical paragangliomas: outcomes of observation of 43 patients. Arch Otolaryngol Head Neck Surg 2012; 138:341.
  84. Glasscock ME 3rd. The history of glomus tumors: a personal perspective. Laryngoscope 1993; 103:3.
  85. Kollert M, Minovi AA, Draf W, Bockmühl U. Cervical paragangliomas-tumor control and long-term functional results after surgery. Skull Base 2006; 16:185.
  86. Zeng G, Zhao J, Ma Y, Huang B. Resection of carotid body tumors and the additional choice of intraoperative shunt in complicated tumors. Ann Vasc Surg 2012; 26:511.
  87. Li-shan L, Chang-wei L, Heng G, et al. Efficacy of surgical therapy for carotid body tumors. Chin Med Sci J 2011; 26:241.
  88. Kruger AJ, Walker PJ, Foster WJ, et al. Important observations made managing carotid body tumors during a 25-year experience. J Vasc Surg 2010; 52:1518.
  89. Phitayakorn R, Faquin W, Wei N, et al. Thyroid-associated paragangliomas. Thyroid 2011; 21:725.
  90. Armstrong MJ, Chiosea SI, Carty SE, et al. Thyroid paragangliomas are locally aggressive. Thyroid 2012; 22:88.
  91. Netterville JL, Reilly KM, Robertson D, et al. Carotid body tumors: a review of 30 patients with 46 tumors. Laryngoscope 1995; 105:115.
  92. Patetsios P, Gable DR, Garrett WV, et al. Management of carotid body paragangliomas and review of a 30-year experience. Ann Vasc Surg 2002; 16:331.
  93. Hallett JW Jr, Nora JD, Hollier LH, et al. Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-year experience with 153 tumors. J Vasc Surg 1988; 7:284.
  94. Paris J, Facon F, Thomassin JM, Zanaret M. Cervical paragangliomas: neurovascular surgical risk and therapeutic management. Eur Arch Otorhinolaryngol 2006; 263:860.
  95. Chan WS, Wei WI, Tse HF. "Malignant" baroreflex failure after surgical resection of carotid body tumor. Int J Cardiol 2007; 118:e81.
  96. Maturo S, Brennan J. Baroreflex failure: a rare complication of carotid paraganglioma surgery. Laryngoscope 2006; 116:829.
  97. Marchesi M, Biffoni M, Nobili-Benedetti R, et al. Surgical treatment of paragangliomas of the neck. Int Surg 1997; 82:394.
  98. Urquhart AC, Johnson JT, Myers EN, Schechter GL. Glomus vagale: paraganglioma of the vagus nerve. Laryngoscope 1994; 104:440.
  99. Prasad SC, Mimoune HA, Khardaly M, et al. Strategies and long-term outcomes in the surgical management of tympanojugular paragangliomas. Head Neck 2016; 38:871.
  100. Forest JA 3rd, Jackson CG, McGrew BM. Long-term control of surgically treated glomus tympanicum tumors. Otol Neurotol 2001; 22:232.
  101. Moe KS, Li D, Linder TE, et al. An update on the surgical treatment of temporal bone paraganglioma. Skull Base Surg 1999; 9:185.
  102. Poe DS, Jackson G, Glasscock ME, Johnson GD. Long-term results after lateral cranial base surgery. Laryngoscope 1991; 101:372.
  103. Pareschi R, Righini S, Destito D, et al. Surgery of Glomus Jugulare Tumors. Skull Base 2003; 13:149.
  104. Powell S, Peters N, Harmer C. Chemodectoma of the head and neck: results of treatment in 84 patients. Int J Radiat Oncol Biol Phys 1992; 22:919.
  105. Ivan ME, Sughrue ME, Clark AJ, et al. A meta-analysis of tumor control rates and treatment-related morbidity for patients with glomus jugulare tumors. J Neurosurg 2011; 114:1299.
  106. Boscà Robledo A, Ponce Marco JL, Belda Ibáñez T, et al. Pheochromocytomatosis: a risk after pheochromocytoma surgery. Am Surg 2010; 76:E122.
  107. Janetschek G, Finkenstedt G, Gasser R, et al. Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 1998; 160:330.
  108. Amar L, Servais A, Gimenez-Roqueplo AP, et al. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab 2005; 90:2110.
  109. Plouin PF, Duclos JM, Soppelsa F, et al. Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. J Clin Endocrinol Metab 2001; 86:1480.
  110. Mitchell J, Siperstein A, Milas M, Berber E. Laparoscopic resection of abdominal paragangliomas. Surg Laparosc Endosc Percutan Tech 2011; 21:e48.
  111. Park JS, Lee KY, Kim JK, Yoon DS. The first laparoscopic resection of extra-adrenal pheochromocytoma using the da Vinci robotic system. J Laparoendosc Adv Surg Tech A 2009; 19:63.
  112. Brown ML, Zayas GE, Abel MD, et al. Mediastinal paragangliomas: the mayo clinic experience. Ann Thorac Surg 2008; 86:946.
  113. Paul S, Jain SH, Gallegos RP, et al. Functional paraganglioma of the middle mediastinum. Ann Thorac Surg 2007; 83:e14.
  114. Hato T, Kaseda K, Harada M, Horio H. Aorticopulmonary paraganglioma. Gen Thorac Cardiovasc Surg 2011; 59:812.
  115. Ramos R, Moya J, Villalonga R, et al. Mediastinal aortosympathetic paraganglioma: report of two cases. Asian Cardiovasc Thorac Ann 2007; 15:e49.
  116. Komatsu T, Shoumura Y, Nasu M, Takahashi Y. Unavoidable arterioplasty of the pulmonary main trunk for complete resection of mediastinal paraganglima--a case report. Thorac Cardiovasc Surg 2007; 55:209.
  117. Pac-Ferrer J, Uribe-Etxebarria N, Rumbero JC, Castellanos E. Mediastinal paraganglioma irrigated by coronary vessels in a patient with an atypical chest pain. Eur J Cardiothorac Surg 2003; 24:662.
  118. Kern JA, Milbrandt TA, Rolf S, Tribble CG. Resection of multiple mediastinal paragangliomas with cardiopulmonary bypass. Ann Thorac Surg 1997; 64:1824.
  119. Herrera MF, van Heerden JA, Puga FJ, et al. Mediastinal paraganglioma: a surgical experience. Ann Thorac Surg 1993; 56:1096.
  120. Yang Y, Wei ZT, Lu JS, et al. Transurethral partial cystectomy with 2 μm thulium continuous wave laser in the treatment of bladder pheochromocytoma. J Endourol 2012; 26:686.
  121. Pandey R, Garg R, Roy K, et al. Perianesthetic management of the first robotic partial cystectomy in bladder pheochromocytoma. A case report. Minerva Anestesiol 2010; 76:294.
  122. Xu DF, Chen M, Liu YS, et al. Non-functional paraganglioma of the urinary bladder: a case report. J Med Case Rep 2010; 4:216.
  123. Cheng L, Leibovich BC, Cheville JC, et al. Paraganglioma of the urinary bladder: can biologic potential be predicted? Cancer 2000; 88:844.
  124. Baima C, Casetta G, Vella R, Tizzani A. Bladder pheochromocytoma: a 3-year follow-up after transurethral resection (TURB). Urol Int 2000; 65:176.
  125. Plouin PF, Chatellier G, Fofol I, Corvol P. Tumor recurrence and hypertension persistence after successful pheochromocytoma operation. Hypertension 1997; 29:1133.
  126. Favia G, Lumachi F, Polistina F, D'Amico DF. Pheochromocytoma, a rare cause of hypertension: long-term follow-up of 55 surgically treated patients. World J Surg 1998; 22:689.
  127. van Heerden JA, Roland CF, Carney JA, et al. Long-term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s). World J Surg 1990; 14:325.
  128. Tanaka S, Ito T, Tomoda J, et al. Malignant pheochromocytoma with hepatic metastasis diagnosed 20 years after resection of the primary adrenal lesion. Intern Med 1993; 32:789.