Abstract
BACKGROUND: Vagal paragangliomas are rare neuroendocrine tumors of the parapharyngeal space, with a small subset exhibiting malignant behavior. Their diagnosis and management remain challenging owing to anatomical complexity and risk of cranial nerve morbidity. CASE PRESENTATION: We report a 46-year-old Maghrebine woman presenting with severe dysphagia and a right lateral cervical mass. Imaging revealed a 40.2 × 40 × 20.6 mm right poststyloid parapharyngeal mass. Surgical excision was performed. Histopathology confirmed metastatic paraganglioma with lymph node involvement, establishing malignancy by current criteria. The patient was referred for adjuvant chemoradiotherapy. CONCLUSION: Malignant vagal paragangliomas require a multidisciplinary approach combining surgery and adjuvant therapies. Genetic testing and long-term follow-up are essential given the risk of metastasis and familial syndromes.