A 44 year old lady presented with weight loss to the gastroenterologists and a CT abdomen done picked up a mass below the pancreas. She underwent a percutaneous biopsy of this mass and the histology revealed a paraganglioma. She was referred to the endocrinology team. Subsequent questioning revealed coexistent symptoms of cataecholamine excess and plasma metanephrines of 4825 pmol/l and plasma normetanephrines of 166 pmol/L gave biochemical confirmation. MIBG scan showed a direct correlation with the CT scan. Genetic studies revealed SDHB mutation linked with familial paragangliomatosis. An MRI arranged in view of complaints of upper leg pains revealed a 2×2.1 cm abnormal signal within the medullary cavity of upper left femur consistent with a metastatic deposit. She underwent excision of her abdominal mass and subsequently had therapeutic MIBG. Repeat staging with MIBG showed good surgical removal of her abdominal mass but persistent left femoral metastasis After discussion in oncology MDT she underwent extracorporeal irradiation of the femoral deposit and re-implantation. The femoral lesion was excised, irradiated, reinserted and plated under low dose alpha blockade. Histology confirmed metastatic paraganglioma. Patient did very well after the procedure with good functional outcome. Conclusion Extracorporeal irradiation (ECI) although used selectively in the management of primary malignant bone tumors since 1996, represents a novel method of treating bony metastasis. Its advantages include lesser radiation dose while providing good functional properties, minimising deleterious effect on biomechanical and biological properties of bone. To our knowledge this is the first case report of its use in the treatment of a metastatic paraganglioma in the English literature.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.