Page 88 - Fluorescence-guided cancer surgery

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Chapter 6
ABSTRACT
Introduction: Intraoperative identi cation of tumors can be challenging. Near- infrared (NIR) uorescence imaging is an innovative technique that can assist in intraoperative identi cation of tumors, which may otherwise be undetectable.
Presentation of case: A 19-year-old patient with symptoms, normetanephrine levels and radiological ndings suspicious for a paraganglioma, a rare tumor arising from extra-adrenal chroma n cells within the sympathetic nervous system, is presented. Intraoperative NIR uorescence imaging using intravenous administration of Methylene Blue (MB) assisted in intraoperative detection of the tumor, and even identi ed a smaller second lesion, which was not identi ed during surgery by visual inspection.
Discussion: Although the exact mechanism of MB accumulation in neuroendocrine tumors is unclear, it is described in both preclinical and clinical studies.
Conclusion: In this report, we describe the rst case of intraoperative NIR uorescence imaging of a paraganglioma using MB, which identi ed an otherwise undetectable lesion.