A NOREPINEPHRINE-SECRETING GLOMIC TISSUE TUMOR (CHEMODECTOMA)

Functional, malignant intrathoracic paraganglioma

This paper describes a case of functional, malignant branchiomeric paraganglioma, the third such to be reported. The patient presented with malignant hypertension and symptoms suggestive of excessive catecholamine secretion.

Intracranial catecholamine secreting paragangliomas

Three intracranial catecholamine-secreting paragangliomas are described. They involved a glomus jugulare, a sphenopalatine ganglion and the clivus and upper cervical spine respectively. The extent of the tumours was shown by CT and MRI. They were all highly vascular with a substantial blood supply from systemic arteries which was subjected to particulate embolisation, followed in two cases by surgery. The importance of studying any tumour which could possibly be a paraganglioma for hormonal and, especially, for catecholamine secretion prior to any invasive procedure, including angiography and embolisation, is emphasised: all such procedures should be covered with catecholamine blocking agents and, in addition, carefully monitored with resuscitation facilities immediately available.

Malignant catecholamine-secreting carotid body paraganglioma

The second known case of a malignant catecholamine-secreting (DA)-secreting carotid body paraganglioma is presented. Dopamine synthesis and secretion can be increased in malignant tumors derived from neural crest cells. Whether this is true, in addition, for extra-adrenal paragangliomas is not yet clear. Malignant paragangliomas of the carotid body and larynx, although rare, frequently have been accompanied by increased catecholamine secretion. Malignant catecholamine-secreting carotid body paragangliomas are best treated by composite resection (internal carotid artery and neck dissection), with special attention being given to measures preventing severe hypertension and arrhythmias in the perioperative period.

Glomus jugulare tumor

A 53-year-old woman with left vocal cord paralysis was seen for sharp shooting pains in the left side of the neck and the left shoulder and upper arm. Glomus jugulare tumor was diagnosed, based on clinical findings and results of angiography and computed tomography. Because surgery was contraindicated, radiotherapy was used. The patient's symptoms resolved within three months, and she had had no further problems. Glomus jugulare tumor should be considered in the differential diagnosis of adult chronic otitis, deafness, tinnitus, and dysfunction of the lower cranial nerves.

Nonfunctional paraganglioma of the larynx: clinical and pathological considerations

Paraganglioma of the larynx is a rare neoplasm. A review of the 16 previously reported cases in English medical literature is presented along with the details of an additional case. The tumor was analyzed by light and electron microscopy. The anatomy and embryology of the laryngeal paraganglia and controversies in nomenclature are discussed. Hoarseness, pain, dysphagia, and neck mass are the cardinal symptoms of this neoplasm; other clinical characteristics are reviewed. Partial laryngectomy and excision via lateral pharyngotomy and extralaryngeal approaches are the most commonly employed methods of treatment. More aggressive therapy including radical neck dissection, total laryngectomy, and radiation therapy have been used for malignancies.

Tracheal paraganglioma: a case report with review of the literature

Only three cases of tracheal paraganglioma have been reported in the literature. This paper describes an additional case, which showed pharmacological and ultrastructural evidence of hormone secretion. It is suggested that this tumor is derived from true paraganglia located in the trachea and not from misplaced or aberrant paraganglionic tissue. Hemoptysis was the only presenting symptom in two of the four reported cases and significant bleeding occurred during biopsy in the other two cases. The long-term prognosis appears good if complete resection is possible.

Aortico-pulmonary paraganglioma: report of a case with ultrastructural study and review of the literature

The light microscopic and ultrastructural features of an aortico-pulmonary paraganglioma (A-PP) are presented. The tumor was characterized by organoid clustering of neoplastic chief cells to form Zellballen. Argyrophilic granules were demonstrated within chief cell cytoplasm using a modified Grimelus technique. Ultrastructurally, three distinct cell types were present within the tumor: endothelial cells, pericytes and neoplastic chief cells. Membrane-bound neurosecretory granules were present and measured 100 to 2000 nm in diameter. "Light" and "dark" chief cells were less distinct than previously reported in other head and neck paragangliomas. Analysis of the 36 documented A-PP reported in the English literature reveals that the tumor has been either incompletely excised or has been considered unresectable in one-third of the cases. The reported surgical mortality is 9%, or approximately equal to the incidence of malignant behavior. The treatment of choice is surgical resection but when this is not possible, radiation may be a useful adjunct in therapy.

Mediastinal paragangliomas (aortic body tumor): a report of four cases and a review of the literature

Four cases of paraganglioma originating in the supra-aortic or aortico-pulmonary bodies are described. A review of the reported examples of aortic body tumors and a study of these four cases indicate that there is a high incidence of aggressive tumor growth in the mediastinum, with resultant important morbidity or death in 16 of 35 cases. The morphologic features of aortic body tumors are identical to those of paragangliomas of other locations, and the occurrence of invasive growth and/or metastasis cannot be predicted on histologic grounds.

Norepinephrine-producing tumors of bilateral breasts: a case report

There was a tumor in the left breast which was suspected to be carcinoid tumor at excisional biopsy. Autopsy revealed the same tumor in the right nipple. In the cells of the bilateral tumors a number of argylophil granules were diffusely demonstrated and the neurosecretory ones were verified electronmicroscopically. In the urine of the patient a moderate amount of norepinephrine was excreted. It was presumed that the norepinephrine might have been produced from the breasts. In the literature reviewed, the case of breast carcinoid has not been reported previously.

Bilateral chemodectoma in the neck

A 55-year-old man with bilateral cervical chemodectoma is reported. The differences between tumours of the carotid body and those of the glomus intravagale are described and a brief review of the investigation and management of such tumours is given.

Paraganglioma of cauda equina

After a brief introduction to the problem of the nature and localisation of sympathetic and parasympathetic paragangliomas a new case of paraganglioma of cauda equina is reported.

Chemodectoma of the vagus nerve. Report of a case with ultrastructural study

Light and electron microscopic studies of a chemodectoma of the vagus nerve are presented. Forty-four cases of vagal chemodectoma have been reported to date, but no electronmicroscopic studies have been published. The ultramicroscopic studies showed the presence of clear and dark cells and membrane-bound neurosecretory granules, and the absence of sustentacular cells and nerve endings. Similar findings have been reported in cases of carotid body and glomus jugulare tumors.