Functioning vagal body tumour

Vagal paragangliomas

The management of vagal paragangliomas is extremely challenging. Treatment of these lesions must be tailored individually for each patient. The best treatment modality depends on the patient's age and health and the size and extent of the tumor. This article discusses clinical presentation, multicentric and malignant vagal paragangliomas, evaluation, embolization, surgical management, and special considerations in the management of vagal paragangliomas.

Dopamine-secreting glomus vagale: a case report and histopathologic correlation

BACKGROUND

Catecholamine secretion by head and neck paragangliomas is uncommon. Dopamine secretion by these tumors has not routinely been assessed. This case report describes a dopamine-secreting glomus vagale and evaluates seven other paragangliomas immunohistochemically for their ability to synthesize dopamine.

METHODS

Light microscopic and immunohistochemical studies were performed on eight tumors, and biochemical testing for serum/urine catecholamines was performed on two patients.

RESULTS

One patient (case report) had elevated serum dopamine which corrected following surgery. Five tumors stained strongly positive for the presence of tyrosine hydroxylase, the critical enzyme in the biosynthesis of dopamine.

CONCLUSION

This case report describes the ability of a glomus vagale to secrete dopamine. Other paragangliomas express the enzymatic machinery necessary to begin catecholamine synthesis. Now that dopamine is routinely screened during catecholamine determination, other cases may be identified.

Malignant vagal paraganglioma

Vagal paraganglioma is a rare usually benign tumour of neural crest origin. The malignant form of this tumour is very uncommon and the diagnosis is made on the basis of its clinical behaviour rather than its histological appearance. We report a case of vagal paraganglioma metastatic to adjacent cervical nodes and discuss the diagnosis and management of this tumour.

Vagal paragangliomas: a report of nine cases

Vagal paragangliomas are rare tumors of neural crest origin: fewer than 175 cases have been reported in the English literature. This slow-growing tumor occurs most often at the base of the skull in the parapharyngeal space, but may arise anywhere along the course of the vagus nerve and its branches. Nine clinical presentations and the surgical outcome in seven patients with vagal paragangliomas treated at our institution are reported. A review of the literature, emphasizing evaluation and treatment of these potentially fatal neoplasms, is discussed. Surgical removal is the treatment of choice with vagal tumors. Complications related to the ablation or injury of cranial nerves IX, X, XI, and XII are commonly seen. Surgical techniques that may prevent injury to these vital neural structures are outlined. The postoperative treatment of patients with impaired deglutition secondary to multiple cranial neuropathies is discussed.