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Palade DO, Hainarosie R, Zamfir A, Vrinceanu D, Pertea M, Tusaliu M, Mocanu F, Voiosu C. Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:914. [PMID: 38929531 PMCID: PMC11205799 DOI: 10.3390/medicina60060914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/19/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and objectives: Paragangliomas of the head and neck are rare, slow-growing neuroendocrine tumors, benign in their vast majority, but with a possibility of developing distant metastases. They show great inheritable character, and their behavior has proven to be unpredictable; therefore, they are considered malignant. Material and methods: This article aims to offer a more comprehensive presentation of the pathogenesis, epidemiology, diagnostic methods, imaging development, and treatment guidelines. We tried to bring together all the necessary data that, in our opinion, a head and neck practitioner should know when managing this type of tumor. Our main focus is on the most recent studies, with the purpose of a homogenous presentation of all current guidelines and approaches to this pathology. Results: Paragangliomas of the head and neck are still a disputed topic. One of the main reasons for that is their low incidence of 0.3 to 1 per 100,000 every year. The most frequent locations are the carotid body, the temporal bone, the jugular and mastoid foramen, and the vagal nerve. Their clinical presentation usually involves a painless lateral mass associated with symptoms such as hoarseness, hearing loss, tinnitus, and cranial nerve deficits. Up to 40% of them are inherited, mostly linked with mutations of succinate dehydrogenase complex. Imaging evaluation consists of CT and MRI, and new functional explorations such as 18F-FDA and 18F-FDG PET/CT, 18F-DOPA PET, 123I-MIBG, and 68Ga-DOTATE PET/CT. Measuring the catecholamine levels in the plasma and urine is mandatory, even though paragangliomas of the head and neck rarely display secretory behavior. Treatment mainly consists of surgery, with different approaches and techniques, but conservative management methods such as wait and scan, radiotherapy, proton therapy, and chemotherapy have proven their efficiency. The therapeutical decision lacks consensus, and current studies tend to recommend an individualized approach. Guidelines regarding long-term follow-up are still a matter of debate.
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Affiliation(s)
- Dragos Octavian Palade
- Surgery Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- ENT Department, “Sf. Spiridon” Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Razvan Hainarosie
- ENT Department, Faculty of Medicine, “Carol Davilla” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adina Zamfir
- ENT Department, “Grigore Alexandrescu” Children’s Emergency Hospital, 011743 Bucharest, Romania
| | - Daniela Vrinceanu
- ENT Department, Faculty of Medicine, “Carol Davilla” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Pertea
- Surgery Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihail Tusaliu
- ENT Department, Faculty of Medicine, “Carol Davilla” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florin Mocanu
- ENT Department, “Sf. Spiridon” Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Catalina Voiosu
- ENT Department, Faculty of Medicine, “Carol Davilla” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Yun J, Kapustin D, Omorogbe A, Rubin SJ, Nicastri DG, De Leacy RA, Khorsandi A, Urken ML. Report of a vagal paraganglioma at the cervicothoracic junction. Head Neck 2023; 45:E36-E43. [PMID: 37548094 DOI: 10.1002/hed.27481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Vagus nerve paragangliomas are rare tumors, comprising 0.03% of head and neck neoplasms. These tumors are usually located cephalad to the hyoid bone, and there is only one previously reported case that arose from the lower third of the neck. METHODS We describe the second reported case of a lower neck vagus nerve paraganglioma that was managed with a limited sternotomy for access and surgical removal. RESULTS A 66-year-old male presented with a long-standing lesion of the cervicothoracic junction. CT, MRI, and Ga-68 DOTATATE PET/CT showed an avidly enhancing 5.2 × 4.2 × 11.5 cm mass extending from C6 to approximately T4 level. FNA confirmed the diagnosis. The patient underwent catheter angiography and embolization via direct puncture technique followed by excision of the mass via a combined transcervical and limited sternotomy approach. CONCLUSION We describe an unusual case of vagal paraganglioma at the cervicothoracic junction with retrosternal extension requiring a sternotomy for surgical excision.
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Affiliation(s)
- Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Danielle Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aisosa Omorogbe
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel J Rubin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel G Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade A De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Meliante PG, Colizza A, Ralli M, Minni A, Angeletti D, Cambria F, de Vincentiis M. Treatment of relapses of benign latero-cervical pathology: a narrative literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S76-S83. [PMID: 37698104 PMCID: PMC10159646 DOI: 10.14639/0392-100x-suppl.1-43-2023-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 09/13/2023]
Abstract
Benign laterocervical pathologies are not without pitfalls. Many may relapse after many years and, sometimes, they cannot be predicted. The purpose of this review is to describe the surgical measures necessary for the treatment of relapses of the most common benign laterocervical masses. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials databases for articles describing the treatment of the most common benign cervical disease recurrences, and summarised available evidence in this narrative review. We overviewed observations about recurrent benign mixed tumour (pleomorphic adenoma), parapharyngeal space tumours and carotid body paragangliomas, thyroglossal duct anomalies and branchial cleft anomalies. Proper surgical technique is crucial for safely and effectively managing the relapses of benign latero-cervical diseases. Radiotherapy is indicated in several cases of recurrence such as pleomorphic adenoma and unresectable paraganglioma. Long-term follow-up is of utmost importance to promptly recognise and treat recurrencies.
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Affiliation(s)
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Heleno C, Lasley K, Low M, Singh P. Vagal paraganglioma clinically presenting as a persistent dry cough. BMJ Case Rep 2021; 14:e241913. [PMID: 34330721 PMCID: PMC8327740 DOI: 10.1136/bcr-2021-241913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/04/2022] Open
Abstract
Vagal paragangliomas (VPs) are a rare subset of neuroendocrine tumour derived from paraganglia located in the head/neck that are usually indolent in nature. Typical clinical presentations include pulsatile tinnitus or hoarseness associated with a neck mass. Surgery and radiation therapy remain the primary treatment modalities but come with significant morbidity including cranial nerve damage. We describe a unique case of VP in which cough was the only presenting symptom, that was exacerbated by enlargement of the tumour. Symptoms improved following radiation treatment.
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Affiliation(s)
- Caio Heleno
- Internal Medicine Department, MercyOne North Iowa Medical Center, Mason City, Iowa, USA
| | - Katharine Lasley
- Internal Medicine Department, MercyOne North Iowa Medical Center, Mason City, Iowa, USA
| | - Michelle Low
- Internal Medicine, MercyOne North Iowa, Mason City, Iowa, USA
| | - Pranav Singh
- Pulmunology Department, MercyOne North Iowa, Mason City, Iowa, USA
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Li L, Xu H, Chen X, Yu Z, Zhou J, Mydlarz WK, London NR. Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model. EAR, NOSE & THROAT JOURNAL 2021; 102:362-368. [PMID: 33829883 DOI: 10.1177/01455613211009441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles. OBJECTIVES This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality. METHODS Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated. RESULTS All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort. CONCLUSION The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, 117902Beijing Tongren Hospital, Capital Medical University, China
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, 117902Beijing Tongren Hospital, Capital Medical University, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, 117902Beijing Tongren Hospital, Capital Medical University, China
| | - Zhenya Yu
- Department of Vascular Surgery, 117902Beijing Tongren Hospital, Capital Medical University, China
| | - Jing Zhou
- Department of Otolaryngology-Head and Neck Surgery, 117902Beijing Tongren Hospital, Capital Medical University, China
| | - Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
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Basel H, Bozan N. Cervical paragangliomas: experience of 114 cases in 14 years. Braz J Otorhinolaryngol 2021; 87:127-131. [PMID: 29936213 PMCID: PMC9422744 DOI: 10.1016/j.bjorl.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/25/2018] [Accepted: 05/01/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction and objective To report a single center experience with carotid body paraganglioma cases that were treated by the same surgeon in a city with high prevalence of paragangliomas due to high altitude. Methods We retrospectively investigated the demographic, clinicopathological and radiological data of 104 patients diagnosed with cervical paragangliomas between 2003 and 2017. The patients were classified according to the Shamblin classification. Results In this study a total of 104 patients (33 male and 71 female, with a mean age of 54.6 ± 13 years) diagnosed with cervical paragangliomas located on carotid bifurcation between 2003 and 2017 were included. Among those patients, 10 presented with bilateral tumors and in total, 114 paragangliomas were managed in this period. The mean diameter of the tumors was 5.12 ± 1.45 cm. Malignant tumor was determined in only one (0.9%) patient. All patients were operated. In 12 patients with the tumor diameter larger than 5 cm, preoperative coil embolization was achieved. In 14 patients, preoperative angiographic embolization was employed and in 4 patients intraoperative sclerosing agent injections were performed. Facial paralysis was observed in 2 patients and dysphagia was present in 1 patient, Horner syndrome was seen in 1 patient and hoarseness was reported in 7 patients after operation. All those complications improved during follow-up. Mortality was not reported in any cases. Conclusion Surgery is the definitive treatment for patients with cervical paragangliomas. Although, it may be difficult in patients with the advanced Shamblin types, in experienced hands, complication rates are very low.
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Affiliation(s)
- Halil Basel
- Lokman Hekim University Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Nazim Bozan
- Yuzuncu Yil University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey
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Maxwell AK, Mehta GU, Muelleman T, Barnard ZR, Hartwick T, Mak A, Brackmann DE, Lekovic GP. Hypofractionated Robotic Stereotactic Radiosurgery for Vagal Paragangliomas: A Novel Treatment Strategy for Cranial Nerve Preservation. Otolaryngol Head Neck Surg 2020; 162:897-904. [PMID: 32125943 DOI: 10.1177/0194599820910150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide the first description of hypofractionated stereotactic radiosurgery (SRS) and evaluate tumor control and safety for vagal paragangliomas (VPs), which begin at the skull base but often have significant extracranial extension. STUDY DESIGN Retrospective chart review. SETTING Tertiary-referral neurotology and neurosurgery practice. SUBJECTS AND METHODS Five VPs in 4 patients (all male, ages 15-56 years) underwent SRS between 2010 and 2018. Outcome measures included tumor dimensions on serial imaging, cranial nerve function, and radiation side effects. RESULTS CyberKnife hypofractionated SRS was performed. The prescription dose was 24 or 27 Gy (maximum dose 33.4 Gy; range, 29.3-35.5 Gy) delivered in 3 equal fractions. The mean isodose line was 79% (range, 76%-82%). Four VPs were treated primarily, and 1 tumor underwent SRS to treat regrowth 2 years after microsurgical subtotal resection via the modified infratemporal fossa approach. The treatment volume ranged from 8.81 to 86.3 cm3 (mean, 35.7 cm3). All demonstrated stable size (n = 3) or regression (n = 2) at last follow-up, 63 to 85 months after SRS (mean, 76 months). One patient had stable premorbid vocal fold paralysis from a prior ipsilateral glomus jugulare tumor resection. All others demonstrated normal vagal function following SRS. Treatment-related side effects, including dysgeusia (n = 1), mucositis (n = 1), and neck soft-tissue edema (n = 2), were self-limited. CONCLUSIONS Hypofractionated SRS appears to be both safe and effective for treating VPs, including large-volume and predominantly extracranial tumors, while preserving vagal function. SRS should be considered as a cranial nerve preservation option, especially in settings of contralateral lower cranial nerve deficits or in those with multiple paragangliomas risking both vagal nerves.
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Affiliation(s)
| | | | | | | | | | - Albert Mak
- Pasadena Cyberknife Center, Pasadena, California, USA
| | | | - Gregory P Lekovic
- House Ear Institute, Los Angeles, California, USA.,Pasadena Cyberknife Center, Pasadena, California, USA
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9
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Schneider R, Elwerr M, Lorenz K, Plontke S, Dralle H, Ukkat J. [Surgical treatment options for cervical paragangliomas]. Chirurg 2019; 90:29-36. [PMID: 30242437 DOI: 10.1007/s00104-018-0734-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The therapies available for the rare tumor entity of cervical paraganglioma (PG) are currently undergoing a paradigm shift. The treatment of choice for small carotid body tumors, malignant and active endocrine tumors is surgical resection; however, for locally advanced carotid body tumors and vagal PG, surgical therapy should be critically evaluated. Due to the immediate proximity of these hypervascularized tumors to the caudal cranial nerves, there is a risk of severe nerve damage with a significant impairment of quality of life after resection, particularly for locally advanced cervical PG, emphasizing further the importance of a restrictive surgical strategy. External radiotherapy can provide an equivalent primary therapeutic option with respect to the rate of recurrence and is accompanied by a lower morbidity. The slow rate of tumor progression and the multifocality of the familial variant of cervical PG or significant comorbidities in older, asymptomatic patients warrant a less aggressive treatment strategy for these tumors. When a wait and scan approach is implemented, a closely monitored radiological and clinical re-evaluation is of upmost importance. In a multidisciplinary approach the following critical points require consideration before a therapy is implemented,: size and location of the tumor, progression rate, genetic background, patient age and general condition, relevant comorbidities, the presence of synchronous PG and/or vasoactive catecholamine-producing tumors. Although best practice algorithms for the treatment of cervical PG have already been devised, recent innovative developments have led to more patient-tailored, individualized treatment approaches.
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Affiliation(s)
- R Schneider
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland.
| | - M Elwerr
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
| | - K Lorenz
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
| | - S Plontke
- Universitätsklinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität, Halle/Saale, Deutschland
| | - H Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - J Ukkat
- Universitätsklinik und Poliklinik für Viszerale, Gefäß und Endokrine Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
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Mendenhall WM, Strojan P, Beitler JJ, Langendijk JA, Suarez C, Lee AW, Rinaldo A, Rodrigo JP, Smee R, Eisbruch A, Harrison LB, Corry J, Ferlito A. Radiotherapy for parapharyngeal space tumors. Am J Otolaryngol 2019; 40:289-291. [PMID: 30621929 DOI: 10.1016/j.amjoto.2018.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
A wide variety of tumors, both benign and malignant, occur in the parapharyngeal space. Depending on histology and extent, treatment may include surgery and/or radiotherapy (RT). Herein we discuss the role of RT in the management of some of the more commonly encountered neoplasms, including salivary gland tumors, paragangliomas, schwannomas, and soft-tissue sarcomas.
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Mendenhall WM, Morris CG, Amdur RJ, Hitchcock KE, Silver NL, Dziegielewski PT. Radiotherapy for benign head and neck paragangliomas. Head Neck 2019; 41:2107-2110. [DOI: 10.1002/hed.25664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/14/2018] [Accepted: 01/04/2019] [Indexed: 01/04/2023] Open
Affiliation(s)
- William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida College of Medicine Gainesville Florida
| | - Christopher G. Morris
- Department of Radiation OncologyUniversity of Florida College of Medicine Gainesville Florida
| | - Robert J. Amdur
- Department of Radiation OncologyUniversity of Florida College of Medicine Gainesville Florida
| | - Kathryn E. Hitchcock
- Department of Radiation OncologyUniversity of Florida College of Medicine Gainesville Florida
| | - Natalie L. Silver
- Department of OtolaryngologyUniversity of Florida College of Medicine Gainesville Florida
| | - Peter T. Dziegielewski
- Department of OtolaryngologyUniversity of Florida College of Medicine Gainesville Florida
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López F, Suárez C, Vander Poorten V, Mäkitie A, Nixon IJ, Strojan P, Hanna EY, Rodrigo JP, de Bree R, Quer M, Takes RP, Bradford CR, Shaha AR, Sanabria A, Rinaldo A, Ferlito A. Contemporary management of primary parapharyngeal space tumors. Head Neck 2018; 41:522-535. [PMID: 30549361 DOI: 10.1002/hed.25439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 01/28/2023] Open
Abstract
The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iain J Nixon
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clínica Vida/Instituto de Cancerología Las Américas, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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14
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Konukiewitz B, Agaimy A, Weichert W, Klöppel G. Neuroendokrine Neoplasien der Kopf-Hals-Region. DER PATHOLOGE 2018; 39:27-34. [DOI: 10.1007/s00292-017-0404-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Head and Neck Paraganglioma: Medical Assessment, Management, and Literature Update. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2017. [DOI: 10.3390/ohbm1010004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Smith JD, Harvey RN, Darr OA, Prince ME, Bradford CR, Wolf GT, Else T, Basura GJ. Head and neck paragangliomas: A two-decade institutional experience and algorithm for management. Laryngoscope Investig Otolaryngol 2017; 2:380-389. [PMID: 29299512 PMCID: PMC5743157 DOI: 10.1002/lio2.122] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/07/2017] [Indexed: 01/02/2023] Open
Abstract
Objectives Paragangliomas of the head and neck and cranial base are typically benign, slow‐growing tumors arising within the jugular foramen, middle ear, carotid bifurcation, or vagus nerve proper. The objective of this study was to provide a comprehensive characterization of our institutional experience with clinical management of these tumors and posit an algorithm for diagnostic evaluation and treatment. Methods This was a retrospective cohort study of patients undergoing treatment for paragangliomas of the head and neck and cranial base at our institution from 2000–2017. Data on tumor location, catecholamine levels, and specific imaging modalities employed in diagnostic work‐up, pre‐treatment cranial nerve palsy, treatment modality, utilization of preoperative angiographic embolization, complications of treatment, tumor control and recurrence, and hereditary status (ie, succinate dehydrogenase mutations) were collected and summarized. Results The mean (SD) age of our cohort was 51.8 (±16.1) years with 123 (63.4%) female patients and 71 (36.6%) male patients. Catecholamine‐secreting lesions were found in nine (4.6%) patients. Fifty‐one patients underwent genetic testing, with mutations identified in 43 (20 SDHD, 13 SDHB, 7 SDHD, 1 SDHA, SDHAF2, and NF1). Observation with serial imaging, surgical extirpation, radiation, and stereotactic radiosurgery were variably employed as treatment approaches across anatomic subsites. Conclusion An algorithmic approach to clinical management of these tumors, derived from our longitudinal institutional experience and current empiric evidence, may assist otolaryngologists, radiation oncologists, and geneticists in the care of these complex neoplasms. Level of Evidence 4
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Affiliation(s)
- Joshua D Smith
- University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Rachel N Harvey
- University of Michigan College of Literature Sciences, and the Arts Ann Arbor Michigan U.S.A
| | - Owen A Darr
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Mark E Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Tobias Else
- Division of Metabolism Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School Ann Arbor Michigan U.S.A
| | - Gregory J Basura
- Department of Otolaryngology-Head and Neck Surgery Kresge Hearing Research Institute Ann Arbor Michigan U.S.A
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Vagal Paraganglioma Presenting as a Neck Mass Associated with Cough on Palpation. Case Rep Otolaryngol 2017; 2017:7603814. [PMID: 28717527 PMCID: PMC5498930 DOI: 10.1155/2017/7603814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022] Open
Abstract
A 70-year-old female presented with a neck mass and sporadic dry cough, often leading to fits of coughing severe enough to cause vomiting. The patient reported that touching the mass triggered the cough. On examination, a 2.5 cm right-sided level two neck mass deep to the sternocleidomastoid was present. Palpation of the mass immediately triggered coughing. Cross-sectional imaging proposed vagal paraganglioma as the chief differential, which was confirmed following surgical excision. The patient reported complete resolution of her severe dry cough after surgery. Vagal paragangliomas are rare neuroendocrine tumors arising from the neural crest-derived paraganglionic tissue surrounding the vagus nerve, typically presenting as a neck mass associated with hoarseness or pulsatile tinnitus. To the best of our knowledge this is a unique description in the English literature. This case is presented to aid physicians should they encounter a neck mass associated with cough. Vagal paraganglioma, although rare, should be part of the differential in such a presentation.
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18
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Deb S, Iseli TA, Wong T, Phal PM. Imaging characteristics of nodal metastases in paraganglioma, ameloblastoma and olfactory neuroblastoma: case reports and literature review. BJR Case Rep 2016; 2:20150096. [PMID: 30459963 PMCID: PMC6243361 DOI: 10.1259/bjrcr.20150096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 12/17/2022] Open
Abstract
Paraganglioma, ameloblastoma and olfactory neuroblastoma are uncommon primary head and neck tumours. When nodal metastases from these tumours occur, they may present later than and with different imaging characteristics compared with squamous cell carcinoma (SCC), demonstrating appearances similar to the primary tumour type rather than features typical of metastatic nodal SCC. We present three cases in which imaging characteristics of nodal metastases in paraganglioma, ameloblastoma and olfactory neuroblastoma mimicked the primary tumour and discuss their implications for clinicoradiological follow-up.
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Affiliation(s)
- Smita Deb
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Tim Anton Iseli
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Timothy Wong
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Pramit M Phal
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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19
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Yuan Y, Shi H, Tao X. Head and neck paragangliomas: diffusion weighted and dynamic contrast enhanced magnetic resonance imaging characteristics. BMC Med Imaging 2016; 16:12. [PMID: 26833065 PMCID: PMC4736670 DOI: 10.1186/s12880-016-0114-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/22/2016] [Indexed: 12/20/2022] Open
Abstract
Background To determine the feature values of head and neck paragangliomas on diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI). Methods Patients with primary head and neck paraganglioma who underwent both DWI and DCE-MRI before treatment between January 2010 and June 2013 were identified. Two radiologists assessed apparent diffusion coefficient (ADC) values on DWI and kinetic characteristics on DCE-MRI. The time intensity curves (TICs) and dynamic parameters, including peak height (PH), maximum enhancement ratio (ERmax), time to peak enhancement (Tpeak) and maximum rise slope (Slopemax), were generated and evaluated. Results Ten patients with head and neck paraganglioma were retrospectively analyzed. On conventional MRI, the tumors demonstrated as well-circumscribed, strongly enhanced lesions. Mean ADC value of the lesions was 1.12 ± 0.15 × 10−3 mm2/s. The TICs demonstrated washout pattern (type-III) in all lesions. The mean PH, ERmax, Tpeak and Slopemax value was 121.24 ± 63.99, 193.79 ± 67.18, 8.16 ± 3.29 and 25.42 ± 7.91, respectively. Conclusions Head and neck paragangliomas demonstrate distinctive DWI and DCE-MRI results than for other benign tumors which should be taken into account in further evaluation of MRI on head and neck lesions.
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Affiliation(s)
- Ying Yuan
- Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Huimin Shi
- Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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20
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McKeown SR, Hatfield P, Prestwich RJD, Shaffer RE, Taylor RE. Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation. Br J Radiol 2015; 88:20150405. [PMID: 26462717 PMCID: PMC4984935 DOI: 10.1259/bjr.20150405] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 12/14/2022] Open
Abstract
Most radiotherapy (RT) involves the use of high doses (>50 Gy) to treat malignant disease. However, low to intermediate doses (approximately 3-50 Gy) can provide effective control of a number of benign conditions, ranging from inflammatory/proliferative disorders (e.g. Dupuytren's disease, heterotopic ossification, keloid scarring, pigmented villonodular synovitis) to benign tumours (e.g. glomus tumours or juvenile nasopharyngeal angiofibromas). Current use in UK RT departments is very variable. This review identifies those benign diseases for which RT provides good control of symptoms with, for the most part, minimal side effects. However, exposure to radiation has the potential to cause a radiation-induced cancer (RIC) many years after treatment. The evidence for the magnitude of this risk comes from many disparate sources and is constrained by the small number of long-term studies in relevant clinical cohorts. This review considers the types of evidence available, i.e. theoretical models, phantom studies, epidemiological studies, long-term follow-up of cancer patients and those treated for benign disease, although many of the latter data pertain to treatments that are no longer used. Informative studies are summarized and considered in relation to the potential for development of a RIC in a range of key tissues (skin, brain etc.). Overall, the evidence suggests that the risks of cancer following RT for benign disease for currently advised protocols are small, especially in older patients. However, the balance of risk vs benefit needs to be considered in younger adults and especially if RT is being considered in adolescents or children.
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Affiliation(s)
| | - Paul Hatfield
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | | | - Richard E Shaffer
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Roger E Taylor
- College of Medicine, Swansea University, South West Cancer Centre, Swansea, UK
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21
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Taweevisit M, Bunyayothin W, Thorner PS. Thyroid Paraganglioma: "Naked" Nuclei as a Clue to Diagnosis on Imprint Cytology. Endocr Pathol 2015; 26:232-8. [PMID: 26116097 DOI: 10.1007/s12022-015-9380-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A cytologic diagnosis of paraganglioma of the thyroid is difficult to make because the thyroid gland is an unusual location for such a tumor and the cytologic findings overlap with other benign and malignant thyroid tumors. We report the case of a 28-year-old female presenting with a solitary mass of the right thyroid gland. A diagnosis of paraganglioma was made on the resected specimen. At the time of tumor resection, imprint cytology was performed. The imprint was hypercellular with cohesive sheets of round cells showing anisokaryosis and anisocytosis. Moreover, there was a second cell type consisting of oval nuclei with dispersed nuclear chromatin present within the sheets and separate as "naked" nuclei. By immunohistochemistry, the cohesive round cells were positive for chromogranin A, indicating chief cells. The naked nuclei were positive for S-100 protein, indicating sustentacular cells. To the best our knowledge, this is the first case report describing naked nuclei as a cytologic feature of paraganglioma. Identification of sustentacular cells provides a clue for the cytologic diagnosis of paraganglioma.
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Affiliation(s)
- Mana Taweevisit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, 1873 King Rama IV Street, Pathumwan, Bangkok, 10330, Thailand,
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Hamersley ERS, Barrows A, Perez A, Schroeder A, Castle JT. Malignant Vagal Paraganglioma. Head Neck Pathol 2015; 10:201-5. [PMID: 25712400 PMCID: PMC4838970 DOI: 10.1007/s12105-015-0621-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
Abstract
Paragangliomas are rare, typically benign neuroendocrine tumors that represent a small portion of head and neck tumors. A small percentage of these are known to have malignant potential. They arise from the carotid body, jugular bulb or vagus nerves. There is limited literature discussing the management of malignant vagal paragangliomas. We present a case of a 25 year old female with a left malignant vagal paraganglioma. The following case presentation will describe the presentation, classic radiologic findings, and management of a malignant vagal paraganglioma along with a review of the literature.
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Affiliation(s)
- Erin R. S. Hamersley
- Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, VA 23708 USA ,3204 Joplin Lane, Chesapeake, VA 23323 USA
| | - Amy Barrows
- Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, VA 23708 USA
| | - Angel Perez
- Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, VA 23708 USA
| | - Ashley Schroeder
- Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, VA 23708 USA
| | - James T. Castle
- Department of Anatomic Pathology, Naval Medical Center Portsmouth, Portsmouth, VA 23708 USA
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23
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Pontes FSC, Mitsuyuki de Brito Kato A, Eduarda de Oliveira Pereira M, Rezende D, Fonseca FP, Vargas PA, Almeida OPD, Pontes HAR. Swelling of the hard and soft palates. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:130-5. [DOI: 10.1016/j.oooo.2014.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/18/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Peric B, Marinsek ZP, Skrbinc B, Music M, Zagar I, Hocevar M. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report. World J Surg Oncol 2014; 12:267. [PMID: 25141773 PMCID: PMC4153909 DOI: 10.1186/1477-7819-12-267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment.We are reporting the case of a 36-year-old man who presented with a painless mass on the right side of his neck 11 months after being treated for testicular cancer. After a fine-needle aspiration biopsy, he was diagnosed with a testicular cancer lymph node metastasis. Neck US and fluorine [F-18]-fluorodeoxy-D-glucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. The patient underwent a level II to V functional neck dissection. During the procedure, suspicion of a carotid paraganglioma was raised and the tumour was carefully dissected from the walls of the carotid arteries with minimal blood loss and no cranial nerve dysfunction.The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes. The patient's history of testicular germ cell tumour led to a functional neck dissection during which a previously unrecognized carotid paraganglioma was removed.Surgery for carotid PG can be associated with complications that have major impact on quality of life. A thorough assessment of the patient and neck mass must therefore be performed preoperatively in order to perform the surgical procedure under optimal conditions.
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Affiliation(s)
- Barbara Peric
- Institute of Oncology Ljubljana, Zaloska 2, Ljubljana 1000, Slovenia.
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25
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Anttila T, Häyry V, Nicoli T, Hagström J, Aittomäki K, Vikatmaa P, Niemelä M, Saarilahti K, Mäkitie A, Bäck LJ. A two-decade experience of head and neck paragangliomas in a whole population-based single centre cohort. Eur Arch Otorhinolaryngol 2014; 272:2045-53. [PMID: 24973967 DOI: 10.1007/s00405-014-3161-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
Abstract
Paragangliomas are rare neuroendocrine tumours arising from neural crest-derived tissue. In the head and neck region typical locations are the carotid bifurcation, vagal nerve or jugulotympanic region. Paragangliomas are normally benign, and malignant transformation is rare. During the past decade the understanding of the genetic and molecular aetiology has had an important clinical impact on the management of PGs. This is a retrospective review of all histologically verified paragangliomas diagnosed and managed at an academic tertiary care referral centre between 1990 and 2010. Data on age, sex, symptoms, tumour location, management and follow-up were recorded. There were 64 patients with 74 tumours. Thirty-six per cent of the tumours were located in the carotid body region, 48 % in the jugulotympanic region and 15 % in the vagal nerve. One tumour was located in the dorsal neck. Most (95 %) of the patients were treated primarily with surgery and with curative intent. Definitive radiation therapy was primarily given to two patients. Recurrent or residual tumours were treated with surgery in three patients and with radiation therapy in nine patients. The typical long-term post-operative sequel was vocal cord paralysis. Local recurrence was found in 6 % of patients. Symptoms and findings related to paragangliomas are variable and management should be individualized. Surgery remains the primary choice of the current treatment options, but often is challenging and warrants a multidisciplinary approach. We present an algorithm on the management of head and neck paragangliomas based on current knowledge.
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Affiliation(s)
- T Anttila
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, 00029 HUS, Helsinki, Finland,
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Kim ES, Kim SY, Mo EY, Jang DK, Moon SD, Han JH. Novel germline SDHD mutation in a patient with recurrent familial carotid body tumor and concomitant pheochromocytoma. Head Neck 2014; 36:E131-5. [PMID: 24599702 DOI: 10.1002/hed.23670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent advances in genetics revealed that 25% to 30% of head and neck paragangliomas (PGLs) are inherited tumors associated with germline mutation, mainly in the succinate dehydrogenase (SDH) gene. METHODS DNA was isolated from whole blood and polymerase chain reaction (PCR) products were sequenced with an ABI3730 × 1 Genetic Analyzer. RESULTS A 30-year-old Korean woman underwent resection of a carotid PGL. Fourteen years later, she was readmitted for a cervical mass. (18) F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT revealed a hot spot in the adrenal gland, besides the carotid mass. Surgical pathology confirmed recurrence of the carotid PGL and a concomitant pheochromocytoma. Genetic analysis revealed SDHD c.119del T (p.I40TfsX46) mutation. One daughter has been identified as a carrier. CONCLUSION We found a novel SDHD mutation from a Korean family that shows similar clinical features to those in other SDHD mutations, mostly from Western countries. Further studies are needed to determine whether similar genotype-phenotype correlations exist in the Asian patients with familial PGLs.
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Affiliation(s)
- Eun Sook Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Incheon St. Mary's Hospital, Incheon, Korea
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Oakes A, Witt B, Adler DG. Metastatic carotid body paraganglioma detected during evaluation for biliary stone disease. Diagn Cytopathol 2014; 42:868-71. [PMID: 24610753 DOI: 10.1002/dc.23038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/22/2013] [Accepted: 08/27/2013] [Indexed: 11/11/2022]
Abstract
Carotid body paragangliomas are neuroendocrine cell tumors. Most invade locally to surrounding tissues with metastases being less commonly encountered than with other tumors: a minority of tumors metastasizes to distal sites. Spread is more unusual after surgical removal of the primary tumor. Hepatic spread is very rare but has been documented. We report a case of a clinically silent metastatic paraganglioma identified during an evaluation for choledocholithiasis. We describe a 70-year-old female presenting with symptoms of abdominal pain who was found to have cholelithiasis and choledocholithiasis. MRI imaging performed during evaluation revealed enhancing liver and lung lesions suspicious for metastasis. FNA of a hepatic lesion showed paraganglioma. She had a remote history of bilateral carotid body tumors, of which the left tumor was resected in 2005. This is a rare case of metastatic carotid body paraganglioma. Primary tumor source was a resected tumor or a smaller sized nodule that was managed with serial imaging. The subject's lack of symptoms and her disease extent with confirmed hepatic and presumed pulmonary spread is unique.
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Affiliation(s)
- Alison Oakes
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Thurtell MJ, Kirby PA, Wall M. Bilateral jugular paragangliomas: a rare cause of raised intracranial pressure. Neurology 2014; 82:732-3. [PMID: 24566226 DOI: 10.1212/wnl.0000000000000149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Matthew J Thurtell
- From the University of Iowa (M.J.T., P.A.K., M.W.) and VA Medical Center (M.J.T., M.W.), Iowa City
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Boedeker CC, Hensen EF, Neumann HPH, Maier W, van Nederveen FH, Suárez C, Kunst HP, Rodrigo JP, Takes RP, Pellitteri PK, Rinaldo A, Ferlito A. Genetics of hereditary head and neck paragangliomas. Head Neck 2013; 36:907-16. [PMID: 23913591 DOI: 10.1002/hed.23436] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/22/2013] [Accepted: 07/19/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to give an overview on hereditary syndromes associated with head and neck paragangliomas (HNPGs). METHODS Our methods were the review and discussion of the pertinent literature. RESULTS About one third of all patients with HNPGs are carriers of germline mutations. Hereditary HNPGs have been described in association with mutations of 10 different genes. Mutations of the genes succinate dehydrogenase subunit D (SDHD), succinate dehydrogenase complex assembly factor 2 gene (SDHAF2), succinate dehydrogenase subunit C (SDHC), and succinate dehydrogenase subunit B (SDHB) are the cause of paraganglioma syndromes (PGLs) 1, 2, 3, and 4. Succinate dehydrogenase subunit A (SDHA), von Hippel-Lindau (VHL), and transmembrane protein 127 (TMEM127) gene mutations also harbor the risk for HNPG development. HNPGs in patients with rearranged during transfection (RET), neurofibromatosis type 1 (NF1), and MYC-associated factor X (MAX) gene mutations have been described very infrequently. CONCLUSION All patients with HNPGs should be offered a molecular genetic screening. This screening may usually be restricted to mutations of the genes SDHD, SDHB, and SDHC. Certain clinical parameters can help to set up the order in which those genes should be tested.
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Affiliation(s)
- Carsten C Boedeker
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs University, Freiburg, Germany
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Subedi N, Prestwich R, Chowdhury F, Patel C, Scarsbrook A. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management. Cancer Imaging 2013; 13:407-22. [PMID: 24240099 PMCID: PMC3830426 DOI: 10.1102/1470-7330.2013.0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neuroendocrine tumours (NETs) of the head and neck are rare neoplasms and can be of epithelial or non-epithelial differentiation. Although the natural history of NETs is variable, it is crucial to establish an early diagnosis of these tumours as they can be potentially curable. Conventional anatomical imaging and functional imaging using radionuclide scintigraphy and positron emission tomography/computed tomography can be complementary for the diagnosis, staging and monitoring of treatment response. This article describes and illustrates the imaging features of head and neck NETs, discusses the potential future role of novel positron-emitting tracers that are emerging into clinical practice and reviews contemporary management of these tumours. Familiarity with the choice of imaging techniques and the variety of imaging patterns and treatment options should help guide radiologists in the management of this rare but important subgroup of head and neck neoplasms.
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Affiliation(s)
- Navaraj Subedi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Sethi RV, Sethi RK, Herr MW, Deschler DG. Malignant head and neck paragangliomas: treatment efficacy and prognostic indicators. Am J Otolaryngol 2013; 34:431-8. [PMID: 23642313 DOI: 10.1016/j.amjoto.2013.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Malignant head and neck paragangliomas (MHNPs) are rare and occur in 6%-19% of all HNPs. We sought to identify predictors of survival and compare efficacy of treatment modalities to inform management of this rare disease. MATERIALS AND METHODS We performed a retrospective cohort study of MHNP cases in the National Cancer Institute Surveillance Epidemiology and End Results database (SEER) from 1973 to 2009. We identified 86 patients with MHNP who had documented regional or distant tumor spread with a median follow-up of 74 months. We used Cox proportional hazard models to assess the significance of demographic factors and treatment on five-year overall survival. RESULTS The most common treatment was surgery alone (36.0 %), followed by surgery with adjuvant radiation (33.7%). Five-year overall survival was 88.1% for surgery alone and 66.5% for adjuvant radiation (p = 0.2251). In univariate analysis, regional (vs. distant) spread (HR 0.23, p < 0.0001), surgery alone (HR 0.29, p < 0.0001) and primary site in the carotid body (HR 0.32, p = 0.006) conferred significant survival advantage whereas age > 50 (HR 4.04, p < 0.0001) worsened survival. Regional (vs. distant) spread (HR 0.42, p = 0.046) and age > 50 (HR 2.98, p = 0.005) remained significant in multivariate analysis. In patients with regional-only disease, five-year overall survival was 95.4% for surgery alone compared to 75.6% for surgery with radiation (p = 0.1055). CONCLUSIONS This is the largest and most contemporary series of MHNP patients. Age and tumor stage are significant factors in predicting survival. Surgical resection significantly improves survival outcomes. From this analysis, the value of adjuvant radiation is not clear.
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Hammer S, Jansen JC, van der Kleij-Corssmit EPM, Hes FJ, Kruit MC. Case of spontaneous regression of carotid body tumor in a SDHD mutant: a discussion on potential mechanisms based on a review of the literature. World J Surg Oncol 2012; 10:218. [PMID: 23083338 PMCID: PMC3500722 DOI: 10.1186/1477-7819-10-218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/14/2012] [Indexed: 12/22/2022] Open
Abstract
Background Head and neck paragangliomas are tumors associated with the parasympathetic nerve system and typically show an indolent growth pattern. Therefore a conservative management strategy is considered in selected cases. Methods and results We present a case of a female patient who presented in 2003 with bilateral carotid body tumors and a tympanic tumor, associated with a mutation in the succinate dehydrogenase -sub-unit-D (SDHD). She was operated on the right carotid body tumor and the tympanic tumor. Thereafter the follow-up was performed with MR examinations at 2-year intervals. After an initial stable phase, over the last 3 years a spontaneous near-total regression of the contralateral carotid body tumor was observed, with only subtle rest-abnormalities visible in 2011. Conclusions The present case underlines the indolent growth pattern of head and neck paragangliomas and for the first time describes a rare manifestation of spontaneous regression of a carotid body tumor. The literature was reviewed to discuss this phenomenon.
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Affiliation(s)
- Sebastiaan Hammer
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, ZA 2333, The Netherlands.
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Schneider R, Ukkat J, Nguyen-Thanh P, Lorenz K, Plontke S, Behrmann C, Sekulla C, Dralle H. [Endocrine surgery for neck paraganglioma: operation, radiation therapy or wait and scan?]. Chirurg 2012; 83:1060-7. [PMID: 22802215 DOI: 10.1007/s00104-012-2326-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Head and neck paraganglioma (HNP) represent rare endocrine tumors. Therapy is decided on genetic findings, tumor characteristics (e.g. tumor size, localization and dignity), age of patient and symptoms. In terms of local control radiation therapy is as equally effective as surgery but surgical morbidity rates secondary to cranial nerve injuries remain high. PATIENTS Based on 6 patients with 11 solitary (4 patients) and multiple (2 patients) HNP (8 carotid body tumors, 1 vagal, 1 jugular and 1 jugulotympanic paraganglioma) the specific characteristics of the need for surgery as well as correct choice of treatment in cases of sporadic succinate dehydrogenase (SDH) negative and hereditary SDH positive HNP will be exemplarily demonstrated. RESULTS A total of 6 carotid body tumors (four sporadic, two hereditary) were resected in 4 patients, five as primary surgery and one as a revision procedure. In one case a preoperative embolization was performed 24 h before surgery. Malignancy could not be proven in any patient. The 30-day mortality was zero. In the patient with bilateral hereditary carotid body tumors, unilateral local recurrent disease occurred. After resection of the recurrent tumor permanent unilateral paralysis of the laryngeal nerve, glossopharyngeal nerve and hypoglossal nerve occurred. All patients were followed-up postoperatively for a mean of 64 months (range 23-78 months) with a local tumor control rate of 100%. The overall survival rate after 5 years was 100%. CONCLUSIONS Given a very strict indication with awareness of surgical risks selective surgery has a key position with low postoperative morbidity in the treatment of HNPs. We prefer surgery for small unilateral paraganglioma, malignant or functioning tumors.
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Affiliation(s)
- R Schneider
- Universitätsklinik und Poliklinik für Allgemein-, Viszeral- und Gefässchirurgie, Martin-Luther-Universität, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland.
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Laryngeal paraganglioma in an irradiated neck. The Journal of Laryngology & Otology 2012; 126:747-50. [DOI: 10.1017/s0022215112000849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We present the first reported case of a paraganglioma of the larynx occurring concurrently with squamous cell carcinoma in an irradiated neck.Method:We present a case report and a literature review of paraganglioma of the larynx.Case report:A 78-year-old woman was found to have a mass on the laryngeal surface of the epiglottis and non-functioning larynx, four months after radical radiotherapy for biopsy-proven squamous cell carcinoma. Repeated positron emission tomography computed tomography was highly suggestive of residual malignancy. Given these findings, and the fact that the patient was aspirating, she was treated with total laryngectomy, and was found to have a paraganglioma of the larynx.Conclusion:This is the first report of such a case. Its importance is three-fold in that it demonstrates: the coexistence of paraganglioma and squamous cell carcinoma; the difficulties that can be encountered in the diagnosis; and the use of radiotherapy in the treatment of paraganglioma.
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Sanna M, Shin SH, De Donato G, Sivalingam S, Lauda L, Vitullo F, Piazza P. Management of complex tympanojugular paragangliomas including endovascular intervention. Laryngoscope 2011; 121:1372-82. [DOI: 10.1002/lary.21826] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/15/2011] [Accepted: 03/18/2011] [Indexed: 11/07/2022]
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