Tx and Followup:
A large mass was found to be intimate with the Left renal artery, but was ultimately resectable. This mass was contiguous with Left adrenal gland, but also extended more medially over top of SMA. Dense lymphatic tissue from tumor extended anterior and posterior to SMA. Mass was noted to be partially fed by arterial source which branched directly from Aorta. Mass was resected and sent to pathology. Upon final abdominal inspection, oozing was noted from splenic capsule. Attending physician believed splenic capsule was likely nicked during surgery and safest option was splenectomy. Splenectomy was performed without further complications.
1) Soft tissue mass - Left peri-adrenal tissue containing firm, 4 x 3.5 x 3.0 cm nodule in fibro-fatty tissue with yellow and brown/tan appearance. Most consistent with paraganglioma.
2) Left adrenal gland - no tumor noted.
3) Spleen - no tumor noted.
DIAGNOSIS: hormonally active para-aortic paraganglioma ("extra-adrenal pheochromocytoma").