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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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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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Menegolo M, Xodo A, Bozza R, Piazza M, Pirri C, Caroccia B, Schiavi F, Opocher G, Antonello M, Grego F. Improving Outcomes in Carotid Body Tumors Treatment: The Impact of a Multidisciplinary Team Approach. Ann Vasc Surg 2021; 75:315-323. [PMID: 33556521 DOI: 10.1016/j.avsg.2021.01.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate how a multidisciplinary approach, including patients and familiar genetic counseling, preoperative succinate-dehydrogenase (SDH) gene mutation analysis, preoperative adjunctive endovascular procedures (PAEPs) and postoperative rehabilitative team may affect the outcomes in patients who underwent surgery for carotid body tumors (CBTs). METHODS Fifty-seven consecutive CBT resections were performed from January 1995 to December 2019 in a single center institution. Two groups of patients were compared: group A (1995-2003; n = 10) and group B (2004-2019; n = 47), treated before and after the establishment of a multidisciplinary approach to CBTs. Group A and group B were evaluated retrospectively and prospectively for SDH mutations, respectively. PAEPs (external carotid artery stenting, percutaneous transfemoral embolization or direct percutaneous puncture of the tumor with simultaneous embolization) were performed only in patients of group B, when the size of the tumor exceeded the 45 mm. Primary endpoints were blood loss (BL) and cranial nerve injuries. Secondary endpoint was the number of new silent masses (NSMs) discovered after genetic evaluation. RESULTS SDH mutations were found in 2 patients of group A and in 11 patients of group B. There were no significant differences in mass diameter between the groups. A significant difference regarding the surgical procedure time was observed in the 2 groups, with a higher time in the group A (Group A: 180 ± 77.3; Group B: 138 ± 54.5, P= 0.04). BL was significantly lower in group B (203 ± 69.5 mL vs. 356 ± 102 mL; P = 0.0001), as well as for patients underwent PAEPs vs. those underwent direct surgery (n = 15, 149 ± 53 mL vs. n = 42, 273 ± 88 mL; P = 0.0001). No differences between transient and persistent cranial nerve injuries were observed between the 2 groups. Carotid reconstruction was necessary for 2 patients of group A (n = 2 vs. n = 0; P = 0.02). Unilateral tumor recurrence was detected in 7 patients, with a significantly higher rate (P ≤ 0.002) in patients carrying SDH mutations compared to those without SDH mutation (wild-type). SDH mutations detected in the groups lead to discover 7 NSMs (group A n = 1 vs. group B n = 6; P = 1.00). CONCLUSION The impact of the multidisciplinary team suggests that surgical resection still remains the gold standard for the treatment of CBTs, but the use of PAEPs in selected cases may reduce surgical procedure time, BL and the need for reconstructive carotid surgery. Genetic counseling and SDH gene analysis allow to diagnose NSMs in asymptomatic patients. Larger studies should be considered to evaluate the effectiveness of postoperative rehabilitative program.
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Affiliation(s)
- Mirko Menegolo
- Division of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Andrea Xodo
- Division of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Riccardo Bozza
- Division of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Carmelo Pirri
- Department of Neuroscience, Institute of Human Anatomy, University of Padua, Padua, Italy
| | | | - Francesca Schiavi
- Familiar Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | | | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Franco Grego
- Division of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Mesko S, Deegan BJ, D'Souza NM, Ghia AJ, Chapman BV, Amini B, McAleer MF, Wang XA, Brown PD, Tatsui CE, Rhines L, Li J. Spine Stereotactic Radiosurgery for Metastatic Pheochromocytoma. Cureus 2019; 11:e4742. [PMID: 31355101 PMCID: PMC6649891 DOI: 10.7759/cureus.4742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Despite aggressive primary treatment, up to 13.5% of patients diagnosed with pheochromocytoma may develop metastases, most often affecting the axial skeleton. Given that systemic therapy options are often inadequate, local therapy remains the cornerstone of palliation for these patients. Historically poor responses to standard fractionated radiotherapy have led to the consideration of stereotactic radiosurgery as an option to overcome potential radioresistance and provide durable local control of these tumors. Here we report our institutional experience in treating spine metastases from pheochromocytoma with spine stereotactic radiosurgery (SSRS). Methods and materials: Our clinical databases were retrospectively reviewed for patients with metastatic pheochromocytoma treated with SSRS from 2000-2017. Seven patients with 16 treated metastatic spinal lesions were identified. Local control was evaluated using magnetic resonance imaging (MRI). Pain and symptom data were assessed to evaluate toxicity using Common Terminology Criteria for Adverse Events (CTCAE) v4.03. The Kaplan-Meier method was used to assess local control and overall survival (OS). Results: Median follow-up for treated lesions was 11 months (range 2.2 - 70.8). Most lesions were treated to a dose of 27 Gy in three fractions (62.5%). Other fractionation schemes included 24 Gy in one fraction (25%), 16 Gy in one fraction (6.3%), and 18 Gy in three fractions (6.3%). Treatment sites included the cervical spine (18.8%), thoracic spine (37.5%), lumbar spine (31.3%), and sacrum (12.5%). The crude local control rate was 93.7%, with one thoracic spine lesion progressing 20.7 months after treatment with 24 Gy in one fraction. Kaplan-Meier OS rates at 1 and 2 years after SSRS were 71.4% and 42.9%, respectively. Most common toxicities included acute grade 1-2 pain and fatigue. There was one case of vertebral fracture in a cervical spine lesion treated to 27 Gy in three fractions, which was managed non-surgically. Conclusion: Very few studies have explored the use of SSRS in metastatic pheochromocytoma. Our data suggest this modern radiation modality is effective, safe, and provides durable local control to palliate symptoms and potentially limit further metastatic seeding. Larger patient numbers and longer follow-up will further define the role of SSRS as a treatment option in these patients.
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Affiliation(s)
- Shane Mesko
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Brian J Deegan
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Neil M D'Souza
- Radiation Oncology, Mays Cancer Center, University of Texas, San Antonio, USA
| | - Amol J Ghia
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bhavana V Chapman
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Behrang Amini
- Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mary Frances McAleer
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Xin A Wang
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Claudio E Tatsui
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Laurence Rhines
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jing Li
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Lin B, Yang H, Yang H, Shen S. Bilateral malignant paragangliomas in a patient: a rare case report. World Neurosurg 2019; 124:12-16. [PMID: 30611952 DOI: 10.1016/j.wneu.2018.12.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Paragangliomas are neuroendocrine neoplasms that arise from the extra-adrenal paraganglia of the autonomic nervous system. Approximately 3% of all paragangliomas occur in the head and neck region. Most reported cases are benign and unilateral. We present here a rare case of bilateral malignant paragangliomas. CASE DESCRIPTION A 28-year-old woman presented to our department with a 10-year history of bilateral neck swelling. Physical examination showed bilateral neck masses with obvious pulsation. Enhanced CT revealed two irregular solid nodules, located in the left and right carotid artery bifurcation, respectively. Carotid artery angiography showed compression of the internal and external carotid arteries by the tumors on both sides. Upon diagnosis of the bilateral carotid body tumors, preoperative embolization was performed. The left-side lesion as well as the lymph nodes were resected and a diagnosis of malignant paraganglioma with lymph node metastasis was made. Genetic studies have shown that familial paragangliomas are associated with germline mutation of succinate dehydrogenase subunits SDHD on 11q23. She was treated with 50-Gy radiotherapy, and a subsequent CT scan performed two years later showed that the right-side lesion was unchanged. She was symptom-free as of the last follow-up. CONCLUSIONS The rarity of bilateral malignant paragangliomas makes their management clinically challenging. The primary management of a recognized malignancy should be directed toward complete surgical removal of the primary tumor and regional lymph nodes. Postoperative radiation is beneficial in slowing the progression of residual disease.
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Affiliation(s)
- Bo Lin
- Department of Oral and Maxillofacial Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Hongyu Yang
- Department of Oral and Maxillofacial Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Huijun Yang
- Department of Oral and Maxillofacial Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Shiyue Shen
- Department of Oral and Maxillofacial Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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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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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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Ikeda A, Shiga K, Katagiri K, Saito D, Miyaguchi J, Oikawa SI, Tsuchida K, Asakage T, Ozawa H, Nibu KI, Ohtsuki N, Fujimoto Y, Kaneko KI. Multi-institutional survey of carotid body tumors in Japan. Oncol Lett 2018; 15:5318-5324. [PMID: 29552173 DOI: 10.3892/ol.2018.7925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022] Open
Abstract
There has been no attempt to clarify the status of patients with carotid body tumor (CBT) in Japan. This multi-institutional survey analyzed patients with CBT throughout Japan by gathering information on these patients from institutions that performed head and neck surgeries. Information from a total of 150 patients from 25 institutions from the past 20 years was employed in the present survey. There were 87 females and 63 males, and their mean age was 48.0 years old. The most common chief complaint was a neck mass and the mean suffering period was 46.1 months. Eighteen patients had a family history of paragangliomas and fifteen patients had bilateral CBTs. Among the 94 patients who underwent surgery to remove a CBT, 23 patients had tumors classified as Shamblin type I, 59 had type II and 12 had type III. The most frequent feeding artery of these CBTs was the ascending pharyngeal artery. Preoperative embolization of these arteries was effective in reducing blood loss; however, the operation time in Shamblin type I and II tumors was not improved. Thus these results revealed the status of patients with CBT and their treatment throughout Japan.
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Affiliation(s)
- Aya Ikeda
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Katsunori Katagiri
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Daisuke Saito
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Jun Miyaguchi
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Shin-Ichi Oikawa
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Kodai Tsuchida
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University School of Medicine, Tokyo 113-8510, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University School of Medicine, Kobe 650-0017, Japan
| | - Naoki Ohtsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University School of Medicine, Kobe 650-0017, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Ken-Ichi Kaneko
- Department of Otolaryngology-Head & Neck Surgery, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
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Garibaldi E, Bresciani S, Panaia R, Delmastro E, Malinverni G, Gabriele P. Hereditary Paraganglioma Syndrome Associated with SDHD Gene Mutations: A Patient with Multicentric Presentation Treated with Radiotherapy. Case Report. TUMORI JOURNAL 2018; 97:214-20. [DOI: 10.1177/030089161109700214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Extra-adrenal paragangliomas are rare tumors arising from neuroendocrine cells. Sporadic and hereditary forms have been recognized. Among the latter, the PGL1 and PGL4 syndromes are associated with a high risk of multiple localizations. The treatment of choice for paragangliomas is surgical resection, but in some cases surgery can be difficult due to particular or multiple tumor sites or may result in severe neurological deficits. In such cases radiotherapy can be an effective alternative. In this paper we describe the case of a patient affected by hereditary paraganglioma syndrome with multicentric presentation who was treated at our center by external radiotherapy. Case report A 55-year-old man presented in April 2008 with multiple paragangliomas: one in the left pontocerebellar angle, two in the middle neck, one mediastinal paraaortic mass, and an abdominal paraaortic lesion. The left pontocerebellar and mediastinal tumors were treated with three-dimensional conformal radiotherapy (3D-CRT) at total doses of 50.40 Gy and 55.80 Gy, respectively. The neck lesions were treated with intensity-modulated radiotherapy (IMRT) at a total dose of 55.80 Gy. The abdominal paraaortic lesion was surgically resected. Results No severe acute or late toxicity as evaluated with the EORTC-RTOG scale was observed. Fourteen months after the end of radiotherapy a whole body CT scan showed that the tumor lesions were stable in size and in their relations to contiguous structures. The arterial pressure was controlled by medical therapy and urine catecholamine levels were within the normal range. Conclusions We believe that in patients affected by unresectable paragangliomas radiotherapy is a safe and effective alternative to surgery. The use of high-dose conformity techniques such as 3D-CRT and IMRT will allow higher local control rates with relatively few side effects thanks to the possibility of dose escalation and reduction of the amount of irradiated healthy tissues.
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Affiliation(s)
- Elisabetta Garibaldi
- Radiotherapy Unit, Institute for Cancer Research and Treatment – IRCC, Candiolo (Turin), Italy
| | - Sara Bresciani
- Medical Physics Unit, Institute for Cancer Research and Treatment – IRCC, Candiolo (Turin), Italy
| | - Rocco Panaia
- Radiotherapy Unit, Institute for Cancer Research and Treatment – IRCC, Candiolo (Turin), Italy
| | - Elena Delmastro
- Radiotherapy Unit, Institute for Cancer Research and Treatment – IRCC, Candiolo (Turin), Italy
| | - Giuseppe Malinverni
- Radiotherapy Unit, Institute for Cancer Research and Treatment – IRCC, Candiolo (Turin), Italy
| | - Pietro Gabriele
- Radiotherapy Unit, Institute for Cancer Research and Treatment – IRCC, Candiolo (Turin), Italy
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Jeevan DS, Saleh M, LaBagnara M, Neil JA, Hillard VH. Malignant carotid body tumor presenting with myelopathy: case report. J Neurosurg Spine 2016; 24:660-3. [PMID: 26722959 DOI: 10.3171/2015.8.spine13483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant carotid body tumors are rare, with spread of the tumor mostly noted in regional lymph nodes. Vertebral metastases are an exceedingly rare presentation, only reported in isolated case reports, and present a diagnostic and management challenge. A case of widespread vertebral metastasis, presenting with myelopathy, from a carotid body tumor is discussed in this paper, along with management strategies.
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Affiliation(s)
- Dhruve S Jeevan
- Department of Neurosurgery, New York Medical College, Valhalla, New York
| | - Mohamed Saleh
- Department of Neurosurgery, New York Medical College, Valhalla, New York
| | - Michael LaBagnara
- Department of Neurosurgery, New York Medical College, Valhalla, New York
| | - Jayson A Neil
- Department of Neurosurgery, New York Medical College, Valhalla, New York
| | - Virany H Hillard
- Department of Neurosurgery, New York Medical College, Valhalla, New York
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Abstract
The authors report a case of orbital paraganglioma--an extremely rare orbital tumor. A 31-year-old woman presented a well-defined localized mass in the superotemporal extraconal aspect of the left orbit. Lateral orbitotomy of the left eye for excisional biopsy was performed, but the tumor could not be excised completely because of bleeding and involvement of critical structure. Histopathology and immunohistochemical analysis established the diagnosis. Gamma knife surgery was used as an alternative modality and resulted in stabilization of the tumor and preservation of her vision. We report a rare case of orbital paraganglioma, successfully managed with radiosurgery after incomplete excision.
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12
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Bacca A, Sellari Franceschini S, Carrara D, Bernini M, Zampa V, Taddei S, Miccoli P, Congregati C, Simi P, Ferrari M, Bernini G. Sporadic or familial head neck paragangliomas enrolled in a single center: clinical presentation and genotype/phenotype correlations. Head Neck 2012; 35:23-7. [PMID: 22290790 DOI: 10.1002/hed.22910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate clinical features and prevalence of germline mutations of patients with head/neck paragangliomas. METHODS Genetic analysis on known susceptibility genes for paragangliomas (VHL, RET, SDHB, SDHC, SDHD, and SDHAF2) was performed in 17 consecutive patients with head/neck paraganglioma (age range, 14-82 years) and 17 relatives. RESULTS Head/neck paragangliomas were usually symptomatic with "mass effect" (88.2%), without family history (82.3%), often multifocal (41.2%), never functioning, and malignant. Germline mutations were detected in 7 of 17 patients (41%; 6 SDHD and 1 SDHB). Patients with mutations were younger, with head/neck paragangliomas usually multifocal and with higher biologic aggressiveness than wild-type subjects. To date, 4 families have been studied and the prevalence of carriers was elevated (58.8%). These mutated relatives (age range, 17-71 years) were disease-free, except 4 patients in whom multiple head/neck paragangliomas were detected. CONCLUSION Adequate morpho-functional screening and follow-up and, if possible, genetic testing is advisable in patients with head/neck paraganglioma.
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Affiliation(s)
- Alessandra Bacca
- Department of Internal Medicine, University of Pisa, Ospedale Santa Chiara, Pisa, Italy
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Peck BW, Rich TA, Jimenez C, Kupferman ME. A novel SDHB mutation associated with hereditary head and neck paraganglioma. Laryngoscope 2012; 121:2572-5. [PMID: 22109755 DOI: 10.1002/lary.22352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe a novel germline mutation in the succinate dehydrogenase subunit B (SDHB) gene. STUDY DESIGN Retrospective review. METHODS The medical records of a patient with bilateral carotid body paragangliomas were reviewed. RESULTS A 35-year-old woman with a family history of neck masses presented with bilateral carotid body paragangliomas. DNA sequencing revealed a previously unreported conservative substitution (Leu111Val) mutation in the SDHB gene. CONCLUSIONS The Leu111Val germline mutation of SDHB is likely associated with a phenotype of head and neck paragangliomas, and carriers would benefit from periodic screening for sympathetic paragangliomas.
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Affiliation(s)
- Brandon W Peck
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Quah RC. Imaging of bilateral neck paragangliomas with 68Ga-DOTATATE positron-emission tomography/CT. AJNR Am J Neuroradiol 2011; 32:E71-2. [PMID: 21436334 DOI: 10.3174/ajnr.a2472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Moskovic DJ, Smolarz JR, Stanley D, Jimenez C, Williams MD, Hanna EY, Kupferman ME. Malignant head and neck paragangliomas: is there an optimal treatment strategy? HEAD & NECK ONCOLOGY 2010; 2:23. [PMID: 20863367 PMCID: PMC2956716 DOI: 10.1186/1758-3284-2-23] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/23/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little is known about management and prognosis for malignant head & neck paragangliomas. We reviewed records of these patients to determine optimal treatment strategies. METHODS We reviewed 113 cases of head & neck paragangliomas treated at our institution from 1970 to 2005. Nineteen patients were included in the study. All had primary surgical treatment at another institution. Metastatic disease was treated with radiation, chemotherapy, or both. Survival and complications were evaluated. P values were determined by Fischer's exact test. RESULTS All patients treated with chemotherapy and radiation age ≥ 40 years had disease progression. Of the patients < 40, two had stable disease; one had regression of disease with treatment. Patients without disease progression had better prognosis and were alive at last follow-up. CONCLUSIONS Clinical benefit was derived from aggressive treatment. However, careful consideration of the risks of observation versus intensive therapy should be undertaken when managing these patients.
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Affiliation(s)
- Daniel J Moskovic
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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Chen PG, Nguyen JH, Payne SC, Sheehan JP, Hashisaki GT. Treatment of glomus jugulare tumors with gamma knife radiosurgery. Laryngoscope 2010; 120:1856-62. [DOI: 10.1002/lary.21073] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mumoli N, Cei M, Pauletti M, Ferrito G, Scazzeri F. Bilateral neck paragangliomas. QJM 2009; 102:733-5. [PMID: 19622673 DOI: 10.1093/qjmed/hcp094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paragangliomas of the head and neck are rare neoplasms presented as cervical mass, generally bilateral, that arise from chemoreceptors located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). They are typically asymptomatic at the beginning, highly vascular, slow-growing and compressing the surrounding anatomic structures. Only radical surgery is the curative treatment for paragangliomas. We present a case of a 62- year-old woman with a diagnosis of bilateral neck paragangliomas where surgical removal was judged burdened by excessive risk because of the size of the tumor.
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Affiliation(s)
- N Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, 57100 Livorno, Italy.
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