title: Long-term follow-up after en bloc resection and reconstruction of a solitary paraganglioma metastasis in the first lumbar vertebral body: a case report.
abstract: BACKGROUND
  Paragangliomas are rare tumors that originate from the autonomic nervous system-associated paraganglia. They metastasize infrequently. Malignancy can only be demonstrated by the presence of chromaffin tissue at sites where it usually is not present, such as bone, lung or liver, or local recurrence after total resection of a primary mass. Paragangliomas within the central nervous system are usually intradural near the conus medullaris. The metastatic spread of a retroperitoneal paraganglioma to a vertebral body is extremely rare, and there are only a few cases reported in the literature.
  
  
  METHODS
  We report the case of a 16-year-old Caucasian girl who had undergone resection of a retroperitoneal paraganglioma that measured 15 × 11.5 × 9.5 cm. After further staging, a solitary metastatic paraganglioma was detected in the first lumbar vertebral body. After initial chemotherapy, marginal en bloc resection and reconstruction were performed followed by radiotherapy. Histologic examination of the specimen revealed that the tumor cells did not show any response to preoperative chemotherapy, which is in line with a few other reports in the literature. Ten years after operative treatment, the patient is free of complaints, very satisfied with the result and without signs of local recurrence or distant metastases.
  
  
  CONCLUSIONS
  We recommend en bloc spondylectomy and local radiotherapy in the treatment of solitary spinal metastatic paragangliomas.
authors.affiliation: Spine Center Hamburg, Asklepios Klinik St, Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany. al.richter@asklepios.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Richter
authors.forename: Henry F
authors.initials: HF
authors.lastname: Halm
authors.forename: Thomas
authors.initials: T
authors.lastname: Lerner
authors.forename: Ulf R
authors.initials: UR
authors.lastname: Liljenqvist
authors.forename: Markus
authors.initials: M
authors.lastname: Quante