Brain metastatic paraganglioma from liver: a case report and review of the literature

Paraganglioma (PGL) is a rare non-epithelial neuroendocrine neoplasm that can occur in multiple locations within the body. Most PGLs grow slowly and are benign, but some can metastasize to distant sites. Reports of brain metastatic PGL are relatively rare, particularly those with comprehensive case histories. A 52-year-old Asian female patient presented with a headache that had persisted for over a month. In 2018, the patient underwent surgical resection of a hepatic mass, with postoperative pathology confirming the diagnosis of primary hepatic PGL. In 2021, she received neurosurgical treatment, and histopathological and molecular analysis of the excised brain tissue revealed mutations in the CD274 , KMT2B , and SDHB genes within the tumor cells. The final integrated pathological assessment confirmed a diagnosis of brain metastatic PGL, classified as a pseudohypoxia-driven subtype. Following temozolomide chemotherapy, no evidence of brain recurrence was observed as of June 2024. However, the patient developed multiple enlarged lymph nodes, with suspicious lesions detected in the thoracic, abdominal, pyramidal, and rib regions. Brain metastatic PGL is relatively rare and presents significant challenges in clinical practice, requiring careful consideration in diagnosis and treatment. Here, we present a case of PGL originating in the liver and metastasizing to the brain, reporting its clinical, radiological, histopathological, and molecular pathological features and the treatment process. A review of the relevant literature is also included to raise clinical awareness of this condition and provide new insights for diagnosis and treatment.