Metastatic Paraganglioma: Recurrence in Uncommon Sites

Paragangliomas are rare neuroendocrine tumors, and mediastinal involvement is exceptionally uncommon. We describe a case of metastatic mediastinal paraganglioma in a 54-year-old woman, occurring 26 years after resection of a retroperitoneal paraganglioma. CT imaging revealed both a posterior mediastinal mass and a liver lesion. FNAC and biopsy from both sites demonstrated features typical of paraganglioma, including zellballen architecture and salt-and-pepper chromatin. The tumor was non-functional. This case highlights the potential for very late metastasis and underscores the need for long-term surveillance, integrated diagnostic evaluation, and genetic testing in paraganglioma management.