Abstract
Mediastinal paraganglioma is a clinically rare neuroendocrine neoplasm. For suspected cases, biochemical detection of plasma and urinary catecholamines and their metabolites is recommended, combined with multimodal imaging (e.g., PET/CT with different tracers) to determine tumor functional status and metastasis. Complete surgical resection remains the treatment of choice; preoperative transcatheter arterial embolization may be considered for highly vascularized tumors to reduce intraoperative bleeding and improve R0 resection rates. Lifelong regular follow-up is advised postoperatively, and sunitinib therapy represents a viable option for recurrent or metastatic disease. This article reports the clinical course of a patient who developed recurrence and metastasis during long-term postoperative follow-up, aiming to enhance clinical understanding of this entity.