Intraoperative near-infrared fluorescence imaging of a paraganglioma using methylene blue: A case report

• A 19-year-old patient diagnosed with a rare neuroendocrine tumor is presented.
• Innovative intraoperative imaging of the tumor was performed.
• NIR fluorescence imaging identified an otherwise undetectable lesion during surgery.
• This technique could result in more complete resections in paraganglioma surgery.

IntroductionIntraoperative identification of tumors can be challenging. Near-infrared (NIR) fluorescence imaging is an innovative technique that can assist in intraoperative identification of tumors, which may otherwise be undetectable.Presentation of caseA 19-year-old patient with symptoms, normetanephrine levels and radiological findings suspicious for a paraganglioma, a rare tumor arising from extra-adrenal chromaffin cells within the sympathetic nervous system, is presented. Intraoperative NIR fluorescence imaging using intravenous administration of methylene blue (MB) assisted in intraoperative detection of the tumor, and even identified a smaller second lesion, which was not identified during surgery by visual inspection.DiscussionAlthough the exact mechanism of MB accumulation in neuroendocrine tumors is unclear, it is described in both preclinical and clinical studies.ConclusionIn this report, we describe the first case of intraoperative NIR fluorescence imaging of a paraganglioma using MB, which identified an otherwise undetectable lesion.