Successful surgical removal of a retroperitoneal paraganglioma in the celiac artery trifurcation in a dog.

Abstract

BACKGROUND: Paraganglioma (PGL) is a general term for tumors that originate in the paraganglia in dogs, most commonly reported in the carotid and aortic bodies. Reports on surgical treatment are rare because these tumors develop near large blood vessels, and their prognosis remains unclear. In dogs, the indications for and safety of surgical procedures involving the celiac artery (CA) root and the dissection of its major branches have not been established. To the best of our knowledge, this is the first reported case of CA root involvement in canine PGL. CASE PRESENTATION: Surgery was performed on day 84 to remove a PGL tumor. The mass was firmly attached to the left lobe of the pancreas, portal vein, CA, and cranial mesenteric artery (CMA). Therefore, a combined resection was performed, including the spleen, left lobe of the pancreas, and left hepatic lymph nodes. Among the main branches of the CA, the splenic and left gastric arteries could not be separated and were transected. Consequently, the stomach wall became ischemic, and reduced pulsation of the left gastric and omental arteries was observed. To maintain blood supply, the common hepatic artery was preserved. After normalization of the stomach wall color, the CMA was separated from the mass, and the tumor was removed. Pathological examination confirmed that the mass was a PGL, with no metastasis to the hepatic lymph nodes. A computed tomography scan on day 265 revealed that blood flow in the common hepatic artery, portal vein, and left gastric region was well maintained. As of day 279, there was no evidence of metastasis or recurrence, and the patient remained in good condition. CONCLUSIONS: In this case, the main branches of the CA, except for the common hepatic artery, were transected to remove the mass; however, the patient was discharged without serious complications. This is attributable to recovery of blood flow from collateral routes. Considering this blood flow recovery and that intraoperative gastric ischemia was temporary, complete ligation of the CA root may be acceptable in some cases. Additionally, the prognosis for PGL was favorable when complete resection was achieved.