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Verma R, Hage N, Gude G. Management dilemmas of tracheal paraganglioma: a case report and review of literature. Ann R Coll Surg Engl 2022; 104:e202-e207. [PMID: 35196162 PMCID: PMC9246544 DOI: 10.1308/rcsann.2021.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Paragangliomas of the trachea are rare neoplasms and can present to the clinician with acute airway problems. These neoplasms sometimes are misdiagnosed by general practitioners as asthmatic exacerbation. We present the case of a 66-year-old woman who presented to us with a history of dyspnoea at rest in the supine position and on exertion and a productive cough. This was diagnosed as bronchial asthma and she was treated with corticosteroid inhalers for four months by her GP. She was subsequently evaluated by computed tomography of the neck and thorax, which revealed an intratracheal enhancing lesion measuring around 11 mm in the lower cervical trachea. Fibreoptic bronchoscopy showed a mass lesion at the level of mid trachea. A low tracheostomy was followed by telescopic examination and the mass was resected using coablation. Histology of the mass was reported as paraganglioma. Difficulties encountered and literature review of various management options are presented in this report.
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Affiliation(s)
- R Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Hage
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G Gude
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Mohan A, Iyer H, Pahuja S, Barwad A. A rare primary tracheal tumor. Lung India 2022; 39:195-198. [PMID: 35259805 PMCID: PMC9053918 DOI: 10.4103/lungindia.lungindia_972_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 20-year-old male without any prior comorbidities presented with 6-month history of hemoptysis as the sole symptom. Clinico-radiological profile and bronchoscopy were suggestive of a tracheal mass. This clinico-pathologic conference discusses the differential diagnoses of primary tumors of the trachea and their management options.
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Kamada M, Shimamoto A, Mori M, Tsutsui S, Zaizen Y, Fukuda M, Matsumoto K, Nagayasu T, Ashizawa K. Tracheal Paraganglioma: A Case report and Review of the Pertinent Literature. Intern Med 2021; 60:2275-2283. [PMID: 33583885 PMCID: PMC8355390 DOI: 10.2169/internalmedicine.5705-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The trachea is a sporadic origin of paraganglioma. The purpose of the present study was to identify the features of tracheal paraganglioma and reveal the effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) by reviewing both previous and current cases. In cases of tracheal tumors, we need to consider the bleeding risk associated with a biopsy, as the tumor may be paraganglioma, which is hypervascular. If a biopsy is not available, then CT and MRI can aid in making a pre-operative diagnosis. MRI in particular is useful for long-term observations.
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Affiliation(s)
| | - Aya Shimamoto
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mio Mori
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shin Tsutsui
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Minoru Fukuda
- Clinical Oncology Center, Nagasaki University Hospital, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kazuto Ashizawa
- Clinical Oncology Center, Nagasaki University Hospital, Japan
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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4
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Tracheal paraganglioma presenting as stridor in a pediatric patient, case report and literature review. INT J PEDIAT OTO CAS 2018. [DOI: 10.1016/j.pedeo.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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5
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Dimachkieh AL, Dobbie A, Olson DR, Lovell MA, Prager JD. Tracheal paraganglioma presenting as stridor in a pediatric patient, case report and literature review. Int J Pediatr Otorhinolaryngol 2018; 107:145-149. [PMID: 29501297 DOI: 10.1016/j.ijporl.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/03/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review tracheal paragangliomas and describe the clinical presentation, radiologic findings, operative management, and histologic findings of a pediatric patient who presented with stridor refractory to traditional asthma therapy. METHODS Chart review of an 8-year-old male who presented to a tertiary care pediatric hospital and literature review of tracheal paragangliomas. RESULTS We present the case of an 8-year-old male who presented with new-onset of wheezing and dyspnea on exertion. He was given a new diagnosis of asthma and treated with bronchodilators that failed to improve his symptoms, which progressed over 3 months until he presented urgently with biphasic stridor. Bedside flexible laryngoscopy failed to reveal an etiology. Computed tomography (CT) imaging demonstrated 17 × 12 × 16 mm exophytic mass arising from the posterior membranous trachea with extension of the mass to the border of the thyroid gland and separate from the esophagus. Magnetic resonance imaging (MRI) angiography confirmed vascular supply from the right thyrocervical trunk and inferior thyroid artery. Rigid microlaryngoscopy revealed a friable vascular polypoid mass 2 cm distal to the vocal folds with 75% obstruction of the airway from which a small biopsy was taken. Pathology confirmed paraganglioma with neuroendocrine cells arranged in "zellballen" architecture and strong immunopositivity for chromogranin and synaptophysin in the neuroendocrine cells and S100 immunopositivity in the sustentacular cells. The patient underwent complete open resection of the tumor including three tracheal rings with primary anastomosis. Final pathology confirmed paraganglioma and negative margins. Genetic screening revealed a succinate dehydrogenase complex subunit C (SDHC) germline mutation, confirming hereditary paraganglioma/pheochromocytoma syndrome. He remains well at 3 month follow up without dyspnea or stridor. CONCLUSION Tracheal paragangliomas are exceptionally rare, with 12 reported cases. This is the only pediatric case reported. In pediatric patients with persistent airway complaints, subglottic and tracheal masses and obstruction should be considered. Due to the vascularity and endotracheal component of tracheal paragangliomas, a detailed surgical plan should consider embolization, endotracheal laser photocoagulation and electrocautery, and open surgical resection. Additionally, pediatric patients benefit from a multidisciplinary approach including radiology, endocrinology, and genetic counseling.
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Affiliation(s)
- Amy L Dimachkieh
- Department of Pediatric Otolaryngology, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO, United States
| | - Allison Dobbie
- Department of Pediatric Otolaryngology, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO, United States
| | - Damon R Olson
- Department of Pathology, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO, United States
| | - Mark A Lovell
- Department of Pathology, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO, United States
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO, United States.
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6
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Pinto FR, de Aquino Capelli F, Maeda SA, Pereira EM, Scarpa MB, Brandão LG. Unusual location of a cervical paraganglioma between the thyroid gland and the common carotid artery: case report. Clinics (Sao Paulo) 2008; 63:845-8. [PMID: 19061012 PMCID: PMC2664290 DOI: 10.1590/s1807-59322008000600024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Sueli Aparecida Maeda
- Department of Pathology, Salomão & Zoppi Medicina Diagnóstica - São Paulo/SP, Brazil
| | | | | | - Lenine Garcia Brandão
- Head and Neck Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil.
, Tel.: 55 11 5058.5738
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Lee KY, Oh YW, Noh HJ, Lee YJ, Yong HS, Kang EY, Kim KA, Lee NJ. Extraadrenal paragangliomas of the body: imaging features. AJR Am J Roentgenol 2006; 187:492-504. [PMID: 16861555 DOI: 10.2214/ajr.05.0370] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This article illustrates the anatomic distribution of the healthy paraganglion system and the imaging and pathologic features of various extraadrenal paragangliomas occurring in the head and neck, chest, and abdomen. CONCLUSION Although paragangliomas can occur in a variety of anatomic locations, the majority are seen in relatively predictable regions of the body. Extraadrenal paragangliomas have nearly identical imaging features, including a homogeneous or heterogeneous hyperenhancing soft-tissue mass at CT, multiple areas of signal void interspersed with hyperintense foci (salt-and-pepper appearance) within tumor mass at MRI, and an intense tumor blush with enlarged feeding arteries at angiography.
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Affiliation(s)
- Ki Yeol Lee
- Department of Radiology, Korea University Anam Hospital, College of Medicine Korea University; #126-1, 5-Ka, Anam-Dong, Sungbuk-Ku, Seoul 136-705, Korea
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Kee AR, Forrest CH, Brennan BA, Papadimitriou JM, Glancy RJ. Gangliocytic paraganglioma of the bronchus: a case report with follow-up and ultrastructural assessment. Am J Surg Pathol 2003; 27:1380-5. [PMID: 14508400 DOI: 10.1097/00000478-200310000-00011] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of gangliocytic paraganglioma of bronchus. A 54-year-old woman underwent bronchoscopy following two episodes of right lower lobe pneumonia over the previous 5 months with unresolved chest radiographic changes. A computerized tomographic scan showed a right lower lobe endobronchial lesion, and at bronchoscopy there was a mass partly occluding the lumen of the bronchus. The biopsy and subsequent bronchoscopic resection showed a tumor with morphologic, immunohistochemical, and ultrastructural features of paragangliomatous, gangliocytic, and Schwann cell differentiation consistent with a gangliocytic paraganglioma. The lesion was treated conservatively with bronchoscopic resection and laser therapy. Histopathologic examination of recurrent tumor at 6 months showed features consistent with paraganglioma. Ten months after initial diagnosis, there was no bronchoscopic evidence of residual tumor. The occurrence of gangliocytic paraganglioma in diverse sites gives cause for the reappraisal of the histogenesis of this fascinating lesion. The variable morphology of this lesion may be an expression of the potential for divergent differentiation of a pluripotent stem cell.
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Affiliation(s)
- Ai-Rene Kee
- Department of Histopathology, Fremantle Hospital, Fremantle, Australia
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9
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Askar I, Oktay MF, Kilinc N. Use of radial forearm free flap with palmaris longus tendon in reconstruction of total maxillectomy with sparing of orbital contents. J Craniofac Surg 2003; 14:220-7. [PMID: 12621294 DOI: 10.1097/00001665-200303000-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Nasal paragangliomas are extremely rare. The most adequate treatment is total excision. After surgical excision requiring total maxillectomy, there has been no ideal technique for reconstruction. A 47-year-old man was admitted to our clinic because of recurrent epistaxis, which lasted for 2 months. He was also suffering from nasal airway obstruction. The physical examination revealed a mass originating from the medial aspect of the middle turbinate of the right nasal cavity. It invaded the anterior maxillary wall and hard and soft palate. Endoscopic examination showed that the mass pushed the nasal septum to the left side and protruded into the nasopharynx. The mass was fleshy and had a rich capillary network. Conventional paranasal sinus radiographs were normal. Computerized tomography of the skull showed the mass protruding into the nasopharynx. A total maxillectomy was performed. Histopathological evaluation showed neoplastic tissue consisting of round, oval, or slightly elongated cells, altogether of a rather monomorphous appearance, tending to arrange themselves in clusters adjacent to or around capillary blood vessels. The blood vessels were numerous and branched. Reticulum staining showed a typical Zellballen arrangement of the neoplastic cells to provide a firmer basis for the diagnosis of paraganglioma. To reconstruct the total maxillectomy defect, a radial forearm free flap with the palmaris longus tendon was elevated to inlay the nasal cavity and the oral cavity and to suspend the ocular globe. The flap was placed into the defect, and the palmaris longus tendon was medially and laterally anchored to the periosteum of the frontal bone to suspend the ocular globe in the orbital cavity. One part of the skin island was used to close the defect of the nasal mucosal cavity, and the other part was used to repair the oral mucosal defect of the palate. Consequently, speech was considered near normal; the patient was able to eat an unrestricted diet and to retain both solid and liquid food inside the oral cavity without drooling, and there was no diplopia or enophthalmos. Six months later, porous polyethylene was inserted and fixed to the zygomatic bone with a miniplate and miniscrews to restore malar contour. No further procedure was believed to be necessary later on. Two years later, a satisfactory and functional esthetic result was obtained, providing an acceptable suspension of the ocular globe and filling of the total maxillectomy defect. We believe that a total maxillectomy is indicated if it is needed in nasal paragangliomas and that microsurgical repair with the composite radial forearm-palmaris longus free flap has several advantages: 1) it can offer en bloc reconstruction of the entire defect after a total maxillectomy in terms of good function and cosmesis; 2) it can repair mucosal defects; and 3) it can anchor and suspend the ocular globe in its original anatomical location, protecting against gravity through the sling effect of the palmaris longus tendon. The composite radial forearm-palmaris longus free flap has not been described previously for suspension of the ocular globe.
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Affiliation(s)
- Ibrahim Askar
- Department of Plastic and Reconstructive Surgery, Dicle University, Medical School, Diyarbakir, Turkey.
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Muley T, Ebert W, Stieber P, Raith H, Holdenrieder S, Nagel D, Fürst H, Roth HJ, Luthe H, Blijenberg BG, Gurr E, Uhl W, von Pawel J, Drings P. Technical performance and diagnostic utility of the new Elecsys neuron-specific enolase enzyme immunoassay. Clin Chem Lab Med 2003; 41:95-103. [PMID: 12636057 DOI: 10.1515/cclm.2003.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This international multicenter study was designed to evaluate the technical performance of the new double-monoclonal, single-step Elecsys neuron-specific enolase (NSE) enzyme immunoassay (EIA) and to assess its utility as a sensitive and specific test for the diagnosis of small-cell lung cancer (SCLC). Intra- and interassay coefficients of variation, determined in five control or serum specimens in six laboratories, ranged from 0.7 to 5.3 (inter-laboratory median: 1.3%) and from 1.3 to 8.5 (inter-laboratory median: 3.4%), respectively. Laboratory-to-laboratory comparability was excellent with respect to recovery and inter-assay coefficients of variation. The test was linear between 0.0 and 320 ng/ml (highest measured concentration). There was a significant correlation between NSE concentrations measured using the Elecsys NSE and the established Cobas Core NSE EIA II in all subjects (n = 723) and in patients with lung cancer (n = 333). However, NSE concentrations were systematically lower (approximately 9%) with the Elecsys NSE than with the comparison test. Based on a specificity of 95% in comparison with the group suffering from benign lung diseases (n = 183), the cut-off value for the discrimination between malignant and benign conditions was set at 21.6 ng/ml. NSE was raised in 73.4% of SCLC patients (n = 188) and was significantly higher (p < 0.01) in extensive (87.8%) as opposed to limited disease (56.7%). NSE was also elevated in 16.0% of the cases with non-small cell lung cancer (NSCLC, n = 374). It is concluded that the Elecsys NSE EIA is a reliable and accurate diagnostic procedure for the measurement of NSE in serum samples. The special merits of this new assay are the wide measuring range (according to manufacturer's declaration up to 370 ng/ml) and a short incubation time of 18 min.
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MESH Headings
- Adenocarcinoma/blood
- Adenocarcinoma/diagnosis
- Adenocarcinoma/enzymology
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Carcinoma, Large Cell/blood
- Carcinoma, Large Cell/diagnosis
- Carcinoma, Large Cell/enzymology
- Carcinoma, Non-Small-Cell Lung/blood
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/enzymology
- Carcinoma, Small Cell/blood
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/enzymology
- Carcinoma, Squamous Cell/blood
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/enzymology
- Case-Control Studies
- Humans
- Immunoassay/methods
- Immunoenzyme Techniques
- Lung/enzymology
- Lung Neoplasms/blood
- Lung Neoplasms/diagnosis
- Lung Neoplasms/enzymology
- Middle Aged
- Phosphopyruvate Hydratase/analysis
- Sensitivity and Specificity
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Affiliation(s)
- Thomas Muley
- Thoraxklinik-Heidelberg gGmbH, Heidelberg, Germany
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Abstract
Primary tracheal tumors are extremely rare, and the majority of them are malignant. Inflammatory pseudotumor is a benign, tumorlike lesion, most likely of a reactive nature. Its basic morphologic characteristic is spindle cell (myoblasts and fibroblasts) proliferation with a variable number and type of inflammatory cells. A case of intratracheal inflammatory pseudotumor in a 14-year-old boy is presented together with a review of all similar lesions in the available literature. The discussion includes the presentation of tracheal tumors, their basic morphologic and immunohistochemical characteristics, and treatment modalities that are available. The surgeon must exercise caution not to perform radical surgery based on the initial pathologic diagnosis from the intraoperative frozen section, because the prognosis of these benign lesions generally is excellent. This is the second reported case of intratracheal inflammatory pseudotumor successfully endoscopically vaporized using a CO(2) laser, which is an excellent alternative in cases in which surgical treatment is feasible. J Pediatr Surg 36:631-634.
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Affiliation(s)
- Z Bumber
- ENT Department, Clinical Hospital Center, Salata 4, 10000 Zagreb, Croatia
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Aijaz F, Salam AU, Muzaffar S, Akbani Y, Hasan SH. Inflammatory pseudotumour of the trachea: report of a case in an eight-year-old child. J Laryngol Otol 1994; 108:613-6. [PMID: 7930907 DOI: 10.1017/s0022215100127604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A polypoid inflammatory pseudotumour was diagnosed in the trachea of an eight-year-old child who presented with asthmatic symptoms. The tumour showed 80 per cent blockage of the lower trachea and consisted of proliferating spindly fibroblastic cells admixed with a variable number of inflammatory cells. The literature on childhood inflammatory pseudotumours is reviewed together with the differential diagnosis of other polypoid mesenchymal tumours of the trachea.
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Affiliation(s)
- F Aijaz
- Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
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13
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Abstract
The trachea is an unusual site for paragangliomas, only four cases having been documented previously. A fifth case is presented here, together with immunohistochemical evidence that the tumour is biologically benign.
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Affiliation(s)
- A P Gallimore
- Department of Histopathology, University College and Middlesex Hospital School of Medicine, London
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14
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Abstract
We present a case of paraganglioma of the thyroid. The preoperative evaluation, surgical management, and histopathology are described. Four similar cases that have been reported are summarized, and a hypothesis for the origin of a paraganglioma within the thyroid capsule is proposed.
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Affiliation(s)
- E J de Vries
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania
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15
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Spagnolo DV, Paradinas FJ. Laryngeal neuroendocrine tumour with features of a paraganglioma, intracytoplasmic lumina and acinar formation. Histopathology 1985; 9:117-31. [PMID: 2579884 DOI: 10.1111/j.1365-2559.1985.tb02975.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A supraglottic laryngeal neuroendocrine tumour in a 71-year-old female is presented. In addition to the typical features of extra-adrenal paragangliomas it showed unusual, numerous intracytoplasmic lumina and occasional true acini with accumulation of alcian blue and PAS positive secretory product in them which led originally to an erroneous diagnosis of metastatic adenocarcinoma. Ultrastructurally, the tumour was composed of light and dark chief cells containing varying numbers of dense-core secretory granules. Intracytoplasmic lumina and true acini contained microvilli with glycocalyceal material and varying amounts of membranous and amorphous material, possibly secreted via small, smooth-surfaced cytoplasmic vesicles but typical mucin granules were not seen. These features have not been previously described in laryngeal paragangliomas but are seen in endocrine tumours of other sites and have been used as an argument in favour of an endodermal rather than ectodermal origin for endocrine cells in those sites. Laryngeal paragangliomas are often malignant and the presence of spasmodic pain appears to be the most reliable indication of possible malignancy, histological criteria being as yet poorly defined.
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Reed DN, Hassan AA, Wilson RF. Primary mucinous adenocarcinoma of the trachea: the case for complete surgical resection. J Surg Oncol 1985; 28:29-31. [PMID: 2982060 DOI: 10.1002/jso.2930280108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Adenocarcinomas of the trachea are rare but important because the only reported treatment in the past (radiation) has resulted in uniformly poor results. The authors recently had the opportunity to treat a young woman with a mucin-producing adenocarcinoma of the trachea. A sleeve resection of the involved trachea with reanastomosis was successful, and the patient is alive and well with no evidence of tumor four years later. Thus, primary resection should be strongly considered for adenocarcinoma of the trachea whenever possible.
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