title: Retroperitoneal paraganglioma presenting with pancytopenia: A rare case with rare manifestation.
abstract: BACKGROUND
  Paragangliomas are tumors that arise from extraadrenal chromaffin cells and most of them are asymptomatic presenting with painless mass. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Surgical resection is still the main treatment and necessary for histological assessment.
  
  
  METHODS
  A 41 year old female patient presented with 6 months of loss of appetite, weight loss, weakness and breathlessness on exertion.. The patient's initial blood examination showed marked anemia, reduced leukocyte count with neutropenia and lymphopenia and a marked reduction in the platelet count. The patient was admitted for evaluation of her pancytopenia. Magnetic resonance imaging revealed a 8×7×8cm sized mass closed to the pancreatic tail invading splenic hilum. A large mass was identified retroperitoneally, closed to the tail of pancreas with a splenic hilum invasion. Total mass resection and splenectomy was performed.
  
  
  CONCLUSIONS
  Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas as well as for recurrent or metastatic neoplasms. Reactive thrombocytosis is a common cause of thrombocytosis. Splenectomy was found to be one of the main causes of extreme reactive thrombocytosis. Reactive thrombocytosis is a predictable finding after splenectomy and management of the thrombocytosis and prevention of complications should be initiated.
authors.affiliation: İzmir University, Department of General Surgery, İzmir, Turkey. Electronic address: mutluunver@gmail.com.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Ünver
authors.affiliation: İzmir University, Department of General Surgery, İzmir, Turkey.
authors.forename: Şafak
authors.initials: Ş
authors.lastname: Öztürk
authors.affiliation: Başkent University, Department of General Surgery, İzmir, Turkey.
authors.forename: Varlık
authors.initials: V
authors.lastname: Erol
authors.affiliation: Aydın State Hospital, Department of General Surgery, Aydın, Turkey.
authors.forename: Erdem Barış
authors.initials: EB
authors.lastname: Cartı
authors.affiliation: Afyon Kocatepe University, Department of General Surgery, Afyon, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Bozbıyık
authors.affiliation: Tepecik Education and Research Hospital, Department of General Surgery, İzmir, Turkey.
authors.forename: Eyüp
authors.initials: E
authors.lastname: Kebapçı
authors.affiliation: Tepecik Education and Research Hospital, Department of General Surgery, İzmir, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ölmez
authors.affiliation: Tepecik Education and Research Hospital, Department of General Surgery, İzmir, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Akbulut
keywords: Pancytopenia; Paraganglioma; Reactive thrombocytosis; Retroperitoneal