Tang Wen, Wang Sheng, Zhou Xudong, Department of Thoracic Surgery, Autonomous Thoracic Hospital (830049) Primary paraganglioma is an extremely rare disease, which is rarely reported at home and abroad. She was admitted to the hospital on September 17, 2008 with the chief complaint of “intermittent cough, chest tightness and shortness of breath for more than 2 years”. The patient reported that she had a cough, no sputum and chest tightness and shortness of breath after getting cold in June 2006 and went to the local hospital. He was given anti-TB drugs regularly for 1 year (12HR/6EZ), and then discontinued in June 2007 after a review at the local epidemic prevention station. Subsequently, the chest X-ray was repeatedly reviewed at the local hospital, indicating “calcification of TB foci”, but due to occasional symptoms of chest tightness and shortness of breath, he was treated with “anti-TB herbs” prescribed by a Chinese medicine clinic for 1 year from August 2008 (details unknown), but the results were not good. The cough, chest tightness and shortness of breath symptoms still appeared from time to time, so he came to our hospital. CT: High-density nodular shadow with clear margins was seen in both lungs, and the lesions were mainly in the lower part of both lungs, and there were no obvious enlarged lymph nodes in both lungs in the mediastinal window, and only a little high-density calcification shadow was seen. He was admitted to our department because of the possibility of hematogenous pulmonary tuberculosis, but not nodular disease. He was in good health and had undergone “right carotid artery hemangiotomy” in 1995, and was cured after the operation. He had no history of exposure to radiation, toxins or dust. Thoracic Surgery Department, Xinjiang Autonomous Region Thoracic Hospital, Tang Wen II, admission examination: T: 36.8℃, p: 84 times/min, R: 21 times/min, Bp: 100/60mmHg, W: 63kg, normal development, normal skin and mucous membrane, no enlargement of superficial lymph nodes, red lips, soft neck, no enlargement of thyroid gland, symmetrical respiratory movements, normal and symmetrical speech fibrillation, no pleural friction, clear sound on percussion, auscultation The breath sounds in both lungs were coarse, and no dry or wet rales were heard. The heart rate was uniform, and no murmur was detected. Abdominal examination was normal. Blood routine: WBC: 4.21×109, RBC: 3.96×1012, ESR: 75mm/h; blood CEA: 1.37ug/L, AFP: 2.03ug/L; TB antibody: 16KDa antibody negative, 32KDa antibody negative, LAM antibody positive; sputum exfoliated cells were not abnormal; sputum smear did not detect antacid bacilli; electrocardiogram: sinus heart The electrocardiogram: sinus rhythm. The nature of diffuse lesions in both lungs is to be investigated, 1, nodular disease, 2, hematogenous tuberculosis? During hospitalization, there was occasional afternoon hypothermia with a maximum temperature of 37.4℃; sputum with a little blood in it once. Because of the presence of diffuse disease in both lungs for 2 years and repeated anti-TB treatment was ineffective, coughing and shortness of breath occurred intermittently, and lung lesions persisted, so a lung biopsy of the lower right lung was performed to clarify the diagnosis. The right lower lung was clearly visible. The right lower lung was partially wedge cut and the cut surface of the nodule was grayish yellow. Postoperative pathological return: combined with immunohistochemical reaction, the lesion was consistent with neuroendocrine tumor (immunohistochemical results: Syn: (+),chr (+),NSE (+),AE1/AE3 (-),EMA (-),Vim (-),CK7 (-),CK19 (-),TTF-1 (-),S-100 (-), as pulmonary paraganglioma. After the diagnosis was clear, the patient did not continue treatment and was automatically discharged from the hospital and followed up by our department. Discussion I. Overview: Primary paraganglioma is an extremely rare disease, also known as chemoreceptor tumor, which was first reported by Heppleston in 1958. There are few reports at home and abroad, and there are no accurate statistics on the incidence. The tumor is found in the peripheral part of the lung at the outer lining of the pulmonary artery and is difficult to distinguish from carcinoid tumors [1]. Review reports are now mostly seen as single, occasionally multiple, but this case of disseminated diffuse paraganglioma has not been reported. Pathology: The tumor is usually located in the subpleural and pulmonary parenchyma, with an intact envelope, round with small lobulated shape, and tough and soft texture. The surface is pink. The tumor cells are large, with abundant and lightly stained cytoplasm, round or polygonal nests of epithelioid cells, and clear nuclear membranes. The nested tumor cells are surrounded by abundant vascular sinuses and reticular fibers. The nesting section of tumor cells penetrated the envelope or invaded the envelope. Electron microscopy showed that most tumor cells contained neurosecretory granules. Tumor cells may be positive for S-100 protein and negative for serotonin. The current concept is that paraganglioma is a neuroendocrine tumor of non-adrenal vegetative nerve cells (or a non-adrenal pheochromocytoma). Its biology is mainly characterized by a slow growth of tumor cells with a multiplication time of about 4.2 years, thus the disease generally has a long course [2]. Clinical manifestations: The tumor is usually found in adults, and it is often found incidentally during physical examination or other medical consultations. Treatment and prognosis: The disease is insensitive to chemotherapy and radiotherapy, and the single one mainly relies on complete surgical resection, and the surgical result is better. The tumor can be malignant, and pathologically it is impossible to distinguish benign from malignant, mainly according to whether there is recurrence or distant metastasis, most of them are benign tumors, and about 10% have malignant tendency and can have local lymph node metastasis [3]. In this case, the patient’s lesion was diffuse and could not be treated surgically, and the imaging manifestation saw no significant change from 2 years ago in the pulmonary corniform lesion, and the patient gave up chemotherapy and radiotherapy. Our department followed up. References 1. Zhang Guoliang, Practical Thoracic Surgery, Title VI Pulmonary Diseases Chapter 6 Pulmonary Benign Tumors Section III Uncharacterized Tumors of Histological Origin 2. He Xiaodong, Clinical Diagnosis and Treatment Analysis of Paraganglioma, Chinese Journal of Medicine, Vol. 4, No. 11, 2004. 3. Yao Weishi, 1 case of primary pulmonary paraganglioma, Southeast Defense Medicine, Vol. 18, No. 2, April 2004.