Virginia Via Research Day Book 2026

Medical Student Research Case Reports

27 PARAGANGLIOMA OF THE LUMBAR SPINE: A CASE REPORT

Michael Farahi-Marney, DO; Madeline Batek, DO; Prutha Patel, OMS-IV; Yash Desai, OMS-IV; Edward Farahi-Marney, OMS-III; Patrick Young, DO; Douglas Green, MD Corresponding author: ppatel04@vcom.edu, ydesai@vcom.edu

VCOM-Virginia, Blacksburg, Virginia; Arkansas College of Osteopathic Medicine, Fort Smith, Arkanas; Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; Unity Health White County Medical Center, Searcy, Arkanas

and gross total resection was achieved with primary dural closure and no CSF leakage. Postoperatively, she completed antibiotics and physical therapy, and by postoperative day three, she was ambulatory, voiding normally, tolerating diet, and discharged home. At her two-week follow-up, she reported improved lumbar pain and radiculopathy, and a seven-week postoperative MRI showed no residual tumor. By four and a half months, she had resumed work without neurological deficits, and repeat imaging again demonstrated no recurrence. Pathologic evaluation of the 2.1 × 2.0 × 2.2 cm mass showed weak pancytokeratin positivity, strong chromogranin A and synaptophysin positivity, and S100 positive sustentacular cells, confirming the diagnosis of paraganglioma. Methods: Literature review was performed using PubMed and Google Scholar with search terms including “lumbar paraganglioma,” “spinal paraganglioma,” “intradural extramedullary tumor,” “paraganglioma recurrence,” and “neuroendocrine spinal tumor.” Lumbar paragangliomas are extremely uncommon, representing only 2-8% of all paragangliomas and occurring at an estimated incidence

of 0.3-2.0 per 100,000. Consistent with previously reported cases, this tumor presented as a benign, nonfunctional, vascular mass producing symptoms through mass effect on the cauda equina. The differential diagnosis often includes schwannoma, ependymoma, and meningioma because MRI features are typically nonspecific. Similar to findings in existing literature, gross total resection remains the optimal management. Reported outcomes show symptomatic improvement in more than 80% of patients and recurrence rates below 5% when complete resection is achieved. This case demonstrated excellent postoperative recovery even without intraoperative neurophysiological monitoring, which some authors recommend but is not universally required. Because recurrence can occur many years after initial resection, especially in cases associated with SDHB mutations, routine surveillance imaging is advise Diagnosis: Lumbar intradural, extramedullary paraganglioma at L3, confirmed with high diagnostic certainty based on pathology and immunohistochemistry. The authors obtained consent from the patient to use their data for this case report.

Context: Lumbar paragangliomas are exceptionally rare neuroendocrine tumors, most commonly arising in the cauda equina. This case highlights an unusual intradural, extramedullary paraganglioma at the L3 level presenting with chronic low back and sacral pain and bilateral lower extremity symptoms. Report of Case: A 49-year-old female presented with chronic, progressive low back and sacral pain described as a “rubber band pulling” sensation in her coccyx, along with bilateral lower extremity numbness and radicular pain. She had multiple emergency department visits and outpatient evaluations for severe pain and suspected urinary tract infections, and chiropractic care provided no relief. Lumbar MRI revealed an ovoid, homogeneously enhancing intrathecal mass at L3, causing significant canal stenosis without calcifications or vertebral involvement. After discussing treatment options, she declined conservative management and elected to undergo surgery. A lumbar laminectomy with intradural exploration identified a vascular, ovoid intradural extramedullary mass that was microdissected from surrounding dura and nerve roots; vascular pedicles were coagulated and divided,

Table of Contents

65

2026 Research Recognition Day