Fig. 23.27 Malignant paraganglioma in the left upper chest. This coned view shows a mass with a well-defined margin lying in the left upper paravertebral region. The patient complained of occasional headaches and sweating but was normotensive. At operation, however, the blood pressure rose steeply while the tumour was being handled. Histological examination showed a paraganglioma which was originally though to be benign. Seven years later, however, the tumour recurred in the chest and metastatic paraganglioma was found on biopsy of a skull lesion. The patient is still alive, seventeen years after initial presentation, after treatment with 131I MIBG.
