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Wang YH, Yang J, Zhong H, Wu JJ, Wu K, Hu A, Wu JY, Zhu JH. Prevalence, characteristics, evaluation, and management of carotid body tumors: Systematic analysis based on available evidence. J Vasc Surg 2024; 80:574-585.e4. [PMID: 38580159 DOI: 10.1016/j.jvs.2024.03.443] [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: 11/21/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Although carotid body tumors (CBTs) are rare, they attract particular attention because of their propensity for malignant transformation and the high surgical risk. Because data are scarce and as it is difficult to achieve a large sample size, no study has yet comprehensively analyzed the characteristics, management, or operative complications of CBTs. Therefore, we collected and analyzed all currently available information on CBTs and used the pooled data to derive quantitative information on disease characteristics and management. METHODS We systematically searched PubMed, Embase, the Cochrane Library, and the Web of Science up to December 1, 2022, for studies that investigated the characteristics and management of CBTs. The primary objective was to identify the prevalence of the various characteristics and the incidence of complications. The secondary objective was to compare patients who underwent preoperative embolization (PE) and those who did not (non-PE), as well as to compare patients with different Shamblin grades and those with and without succinate dehydrogenase (SDH) mutations in terms of CBT characteristics and complications. Two reviewers selected studies for inclusion and independently extracted data. All statistical analyses were performed using the standard statistical procedures of Review Manager 5.2 and Stata 12.0. RESULTS A total of 155 studies with 9291 patients and 9862 tumors were identified. The pooled results indicated that the median age of patients with CBT was 45.72 years, and 65% were female. The proportion of patients with bilateral lesions was 13%. In addition, 16% of patients had relevant family histories, and the proportion of those with SDH gene mutations was 36%. Sixteen percent of patients experienced multiple paragangliomas, and 12% of CBTs had catecholamine function. The incidence of cranial nerve injury (CNI) was 27%, and 14% of patients suffered from permanent CNI. The incidence rates of operative mortality and stroke were both 1%, and 4% of patients developed transient ischemic attacks. Of all CBTs, 6% were malignant or associated with metastases or recurrences. The most common metastatic locations were the lymph nodes (3%) and bone (3%), followed by the lungs (2%). Compared with non-PE, PE reduced the estimated blood loss (standardized mean difference, -0.95; 95% confidence interval [CI], -1.70 to -0.20) and the operation time (standardized mean difference, -0.56; 95% CI, -1.03 to -0.09), but it increased the incidence of stroke (odds ratio, 2.44; 95% CI, 1.04-5.73). Higher Shamblin grade tumors were associated with more operative complications. Patients who were SDH gene mutation-positive were more likely to have a relevant family history and had more symptoms. CONCLUSIONS CBT was most common in middle-aged females, and early surgical resection was feasible; there was a low incidence of serious operative complications. Routine PE is not recommended because this may increase the incidence of stroke, although PE somewhat reduced the estimated blood loss and operation time. Higher Shamblin grade tumors increased the incidence of operative complications. Patients who were SDH gene mutation-positive had the most relevant family histories and symptoms.
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Affiliation(s)
- Yong-Hong Wang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jia Yang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Hao Zhong
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jun-Jie Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Kai Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Anguo Hu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Jian-Ying Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China
| | - Ji-Hai Zhu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi'ning, China; Medical College of Qinghai University, Qinghai University, Xi'ning, China.
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Wang H, Li Z, Yao C, Wang M, Hu Z, Wu R, Chang G. Perioperative evaluation and follow-up analysis of carotid body tumor by Color Doppler Ultrasound. Ann Vasc Surg 2024:S0890-5096(24)00396-0. [PMID: 39009121 DOI: 10.1016/j.avsg.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/17/2024] [Accepted: 05/02/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES The value of Color Doppler Ultrasound (CDU) for perioperative evaluation and follow-up outcomes of carotid body tumor (CBT) remains elusive. This study aimed to investigate the role of CDU in CBT in our center. METHODS From January 2015 to December 2020, 75 patients with CBT were included in the study. Computed Tomography Angiography (CTA) and CDU data of patients were collected and analyzed. The postoperative recovery and follow-up outcomes were summarized. RESULTS A total of 91 CBTs in 75 patients were included in the study. 73.3% of patients had unilateral lesions, while 26.7% had bilateral lesions. Lesions were categorized as Shamblin I (4.4%), Shamblin II (52.7%), and Shamblin III (42.9%). 79.5% lesions were treated by surgical resection, 12.3% were treated by surgical resection with internal carotid artery reconstructed by artificial vessel, while 8.2% were treated by surgical resection with internal carotid artery reconstructed by autogenous great saphenous vein. Compared with CTA, the sensitivity of CDU for detection of CBT was 96.7%, the sensitivity and specificity of CDU for detection of Shamblin Ⅰ lesions were both 100%, the sensitivity and specificity for Shamblin Ⅱ were 100% and 72.1%, respectively, while the sensitivity and specificity for Shamblin Ⅲ were 69.2% and 100%, respectively. There were no statistically significant differences between CTA and CDU for detection of the maximal diameter, volume of CBT and distance between the end of the tumor and the mastoid process. 79.7% of patients were followed up with CDU. Recurrence of CBT occurred in 1 patient. CDU showed that stenosis and occlusion of artificial vessel occurred in 1 and 6 patients, respectively. Occlusion of autogenous great saphenous vein was found in 2 cases. CONCLUSIONS CDU can accurately diagnose Shamblin Ⅰ CBT, have high sensitivity for Shamblin Ⅱ and high specificity for Shamblin Ⅲ CBT. It plays an important role in diagnosis, perioperative evaluation and follow-up analysis of CBT.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Zilun Li
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Chen Yao
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Mian Wang
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Zuojun Hu
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Ridong Wu
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University. Guangzhou, China.
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Işık M, Kılınç F, Dereli Y, Tanyeli Ö, Yıldırım S, Alakuş R, Arbağ H, Görmüş N. Surgical and Histopathological Results in Carotid Body Tumors. Thorac Cardiovasc Surg 2024. [PMID: 38777328 DOI: 10.1055/a-2331-2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The possible relationships between the histopathological findings of carotid body tumors and age, gender, tumor diameter, and Shamblin classification were investigated. In addition, preoperative embolization status, development of neurological complications, need for vascular reconstruction, hemoglobin change, and discharge time were examined and the effects of these variables on each other were analyzed. METHODS Between 2008 and 2022, 46 cases who underwent carotid body tumor excision were examined retrospectively. The cases were followed for an average of 81 months postoperatively. Histopathological materials were reexamined and the effect of categorical variables was analyzed. RESULTS Mean tumor diameter was 3.55 ± 1.26 cm, mean discharge time was 3.91 ± 2.37 days, and mean hemoglobin change was 1.86 ± 1.25. Neurological complications developed in 13% of cases. The amount of hemoglobin change was significantly (p = 0.003) higher in those who developed neurological complications, whereas the tumor diameter and discharge time were found to be insignificantly higher. Surgical complications requiring vascular repair occurred in 10.8% of cases. Tumor diameter (p = 0.017) and hemoglobin change (p = 0.046) were significantly higher in these patients. There were significant correlations between higher Shamblin classification and tumor diameter, discharge time, postoperative hemoglobin value, and number of surgical and neurological complications. No significant difference was found between Ki-67, capsular invasion, mitosis, pleomorphism, prominent nucleoli, mean island diameter, and tendency of islands to merge with categorical variables. CONCLUSION As the tumor diameter increases, the operation becomes more difficult and the postoperative complication rate increases. We think that subadventitial and capsular removal of the tumor is effective in preventing recurrence. To reach a histopathological conclusion, a larger series of studies including tumors with high Ki-67 and mitosis rates, large size, and one or more of the criteria for necrosis are needed.
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Affiliation(s)
- Mehmet Işık
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Medical Faculty Hospital, NEÜ Meram Tıp Fakültesi Kalp ve Damar Cerrahisi, Konya, Turkey
| | - Fahriye Kılınç
- Department of Pathology, Necmettin Erbakan Üniversitesi, Konya, Turkey
| | - Yüksel Dereli
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Medical Faculty Hospital, NEÜ Meram Tıp Fakültesi Kalp ve Damar Cerrahisi, Konya, Turkey
| | - Ömer Tanyeli
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Medical Faculty Hospital, NEÜ Meram Tıp Fakültesi Kalp ve Damar Cerrahisi, Konya, Turkey
| | - Serkan Yıldırım
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Medical Faculty Hospital, NEÜ Meram Tıp Fakültesi Kalp ve Damar Cerrahisi, Konya, Turkey
| | - Rabia Alakuş
- Department of Pathology, Necmettin Erbakan Üniversitesi, Konya, Turkey
| | - Hamdi Arbağ
- Department of Ear Nose and Throat Surgery, Necmettin Erbakan University, Konya, Turkey
| | - Niyazi Görmüş
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram Medical Faculty Hospital, NEÜ Meram Tıp Fakültesi Kalp ve Damar Cerrahisi, Konya, Turkey
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Ali MA, Attia A, Farahat IG. Outcomes of Head and Neck Neurogenic Tumors. Cureus 2024; 16:e61156. [PMID: 38933607 PMCID: PMC11200936 DOI: 10.7759/cureus.61156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Lateral neck mass management frequently challenges surgeons. Nerve tissue neoplasms are an uncommon cause of such nodules. Neurogenic tumors form a tiny percentage of the head and neck neoplastic lesions. Considering the number of nerves in this area, it is surprising that such neoplasms are not more frequently seen. METHODS A retrospective study was conducted on all patients who presented to the National Cancer Institute of Cairo, Egypt, with head and neck neurogenic neoplasms. RESULTS During the last 10 years at the National Cancer Institute of Egypt (2006-2015), 40 cases of neurogenic tumors of the head and neck were treated at the head and neck unit. Patients' ages ranged from two to 78 years with a mean age of 34.7 years. Childhood neurogenic tumors accounted for nine cases (22.5%) only in this study. Male patients diagnosed with these tumors comprised 16 cases, while female patients comprised 24 cases, with a female-to-male ratio of 1.5:1. Patient presentation depends on the biological behavior of the tumor; for instance, some of them present by slowly growing painless well-circumscribed mobile swelling, and others present by rapidly growing swelling with neurological deficit. Clinical picture and imaging studies such as CT and MRI raise suspicion and may help delineate such tumors, but a definitive diagnosis is obtained by tissue biopsy. Surgery is the mainstay of treatment in most head and neck neurogenic tumors, whereas adjuvant therapy is of limited benefit in some types of neurogenic tumors. The five-year survival rate was 60% for the malignant group, while death was reported in six out of 15 cases (40%). Conclusion: Most neurogenic head and neck tumors are benign. Accurate preoperative assessment and a high degree of suspicion are the initial steps in the management. Proper treatment involves complete surgical excision; however, debulking procedures have an important role. Malignant neurogenic tumors are aggressive and are treated with combined radical surgical resection and radiation. Chemotherapy is tried for locally advanced unresectable or metastatic disease.
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Affiliation(s)
- Mohamed A Ali
- Head and Neck Surgery, National Cancer Institute, Cairo, EGY
| | - Amr Attia
- Head and Neck Surgery, National Cancer Institute, Cairo, EGY
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Abdullah A, Hamzah A, Alsudais AS, Alzahrani RS, Souror H, Alqarni GS, Ashqar AA, Hemeq YH, Dakkak O. A Global Bibliometric Analysis of the Top 100 Most Cited Articles on Carotid Body Tumors. Cureus 2024; 16:e54754. [PMID: 38524015 PMCID: PMC10961149 DOI: 10.7759/cureus.54754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
The carotid body, situated at the common carotid artery bifurcation, comprises specialized glomus cells responsible for sensing blood oxygen, carbon dioxide, pH, and temperature changes, crucial for regulating breathing and maintaining oxygen homeostasis. Carotid body tumors (CBTs), arising from these cells, are rare, representing only 0.5% of head and neck tumors, often presenting as benign, slow-growing, vascularized masses. In February 2023, this bibliometric analysis was conducted, which involved screening 1733 articles from the Web of Science database. The screening process was based on citation count, and articles were selected for inclusion based on specific criteria that focused on CBTs located within the carotid bifurcation. Rigorous selection involved independent screening and data extraction by four authors. The top 100 articles, published between 1948 and 2019, totaled 6623 citations and were authored by 98 unique first authors from 22 countries and 77 institutions, spanning 42 journals. Treatment articles were the predominant category, comprising 49% of the literature. This analysis offers insights into publication trends, identifies literature gaps, and outlines areas of research focus, providing a valuable resource to guide future studies on CBTs.
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Affiliation(s)
- Abdullah Abdullah
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulaziz Hamzah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ali S Alsudais
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Raghad S Alzahrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hatem Souror
- College of Medicine, University of Jeddah, Jeddah, SAU
| | | | - Afnan A Ashqar
- College of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Yousef H Hemeq
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Omar Dakkak
- Department of Surgery (Vascular Surgery), International Medical Center Hospital, Jeddah, SAU
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6
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Mahajan A, Shaikh A, Shukla S, Vaish R, Agarwal U, Smriti V, Rastogi S, Deokar S, Suryavanshi S, Chaturvedi P, Laskar SG, Prabhash K, Patil V, Noronha V, Menon N, Pai P, Pantvaidya G, Rane SU, Bal M, Mittal N, Patil A, Dcruz AK. MR imaging-based risk stratification scoring system to predict clinical outcomes in carotid body tumors. Front Oncol 2024; 13:1200598. [PMID: 38348117 PMCID: PMC10860202 DOI: 10.3389/fonc.2023.1200598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Objectives This study aims to evaluate the role of pretherapy MRI in predicting outcomes in carotid body tumors and propose a grading system for high- and low-risk characteristics. Materials and methods A retrospective observational study of 44 patients with 51 lesions was carried out from year 2005 to 2020. MR images were reviewed for characteristics of carotid body tumor, and a score was given that was correlated with intra- and postoperative findings. The various other classifications and our proposed Mahajan classification were compared with Shamblin's classification. The area under the curve and ROC curves were used to present the accuracy of different predictive models. Results Our scoring system allotted a score of 0 to 15 on the basis of MRI characteristics, with scores calculated for patients in our study ranging from 0 to 13. Lesions with scores of 0-6 were considered low risk (45%), and scores of 7-15 were regarded as high risk for surgery (55%). The Mahajan classification stages tumors into four grades: I (10%), II (20%), IIIa (8%), and IIIb (62%). The frequency of vascular injury was 50% in category I and 64% in category IIIb. The frequency of cranial nerve injury was 50%, 66%, and 27% in categories I, II, and IIIb. Conclusion The Mahajan classification of CBTs evaluates high-risk factors like the distance of the tumor from the skull base and the angle of contact with ICA, which form the major predictors of neurovascular damage and morbidity associated with its surgery. Though the Shamblin classification of CBT is the most widely accepted classification, our proposed Mahajan classification system provides an imaging-based alternative to prognosticate surgical candidates preoperatively.
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Affiliation(s)
- Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Atif Shaikh
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shreya Shukla
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Richa Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | | | - Shivam Rastogi
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shonal Deokar
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nandini Menon
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Anil Keith Dcruz
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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7
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Rahman MA, Venkataram T, Habib R, Jahan N, Raihan F, Alam S, Mahmood E, Umana GE, Chaurasia B. Synchronous Carotid Body and Glomus Jugulare Tumors : A Case Report and Review of Literature. J Korean Neurosurg Soc 2024; 67:122-129. [PMID: 37643721 PMCID: PMC10788546 DOI: 10.3340/jkns.2022.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/27/2023] [Accepted: 04/17/2023] [Indexed: 08/31/2023] Open
Abstract
Paragangliomas are rare neuroendocrine tumors that are usually benign in nature. They may be either familial or sporadic in their occurrence. Numerous neuroendocrine tumors are collectively included under the umbrella of paragangliomas. Among them, carotid body tumors and glomus jugulare tumors are extremely rare. Thus, we present a rare case of 29-year-old male who was admitted with hearing difficulties and tinnitus in the left ear, with swelling on the left side of the neck. Based on clinical and radiological findings, a diagnosis of left-sided glomus jugulare with carotid body tumor was made. The patient underwent a twostage surgery with an interval of approximately 2 months. Histopathology revealed a paraganglioma. Herein, we present the clinical features, imaging findings, management, and a brief review of literature on the classification, evaluation, and management of carotid body and glomus jugulare tumors. Paraganglioma is a slow-growing tumor. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Microsurgical resection remains the primary treatment modality. Therefore, our patient underwent two-stage surgery. The rarity of occurrence and the proximity and adherence to vital neurovascular structures have resulted in the treatment of paragangliomas remaining a challenge.
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Affiliation(s)
- Md Atikur Rahman
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Bangladesh
| | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Riad Habib
- Department of Neurosurgery, Enam Medical College, Savar, Bangladesh
| | - Nwoshin Jahan
- Department of Neurosurgery, Combined Military Hospital (CMH), Dhaka, Bangladesh
| | - Farid Raihan
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Bangladesh
| | - Shamsul Alam
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Bangladesh
| | - Ehsan Mahmood
- Department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Verghis NM, Brown JA, Yousef S, Aranda-Michel E, Serna-Gallegos D, Levenson J, Ogami T, Diaz-Castrillon C, Thoma F, Singh M, Sultan I. Long-Term Outcomes of Patients With Carotid and Aortic Body Tumors. Am J Cardiol 2023; 199:78-84. [PMID: 37262989 DOI: 10.1016/j.amjcard.2023.05.003] [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] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
Chemodectomas are tumors derived from parasympathetic nonchromaffin cells and are often found in the aortic and carotid bodies. They are generally benign but can cause mass-effect symptoms and have local or distant spread. Surgical excision has been the main curative treatment strategy. The National Cancer Database was reviewed to study all patients with carotid or aortic body tumors from 2004 to 2015. Demographic data, tumor characteristics, treatment strategies, and patient outcomes were examined, split by tumor location. Kaplan-Meier survival estimates were generated for both locations. In total, 248 patients were examined, with 151 having a tumor in the carotid body and 97 having a tumor in the aortic body. Many variables were similar between both tumor locations. However, aortic body tumors were larger than those in the carotid body (477.80 ± 477.58 mm vs 320.64 ± 436.53 mm, p = 0.008). More regional lymph nodes were positive in aortic body tumors (65.52 ± 45.73 vs 35.46 ± 46.44, p <0.001). There were more distant metastases at the time of diagnosis in carotid body tumors (p = 0.003). Chemotherapy was used more for aortic body tumors (p = 0.001); surgery was used more for carotid body tumors (p <0.001). There are slight differences in tumor characteristics and response to treatment. Surgical resection is the cornerstone of management, and radiation can often be considered. In conclusion, chemodectomas are generally benign but can present with metastasis and compressive symptoms that make understanding their physiology and treatment important.
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Affiliation(s)
- Nina M Verghis
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Josh Levenson
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carlos Diaz-Castrillon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael Singh
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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9
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Gupta R, Dyba G, Malgor EA, Campana J, Nehler M, Malgor RD. Morbidity and Long-Term Patient-Reported Outcomes Following Advanced Carotid Body Tumor Resection. Ann Vasc Surg 2023; 92:49-56. [PMID: 36736720 DOI: 10.1016/j.avsg.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND The reported risk of a cranial nerve (CN) injury is up to 1 in 4 patients in large registries of carotid body tumor (CBT) resection. Functional outcome for this population is unknown. METHODS We evaluated consecutive patients who underwent CBT resection from November 2013 through October 2020. Demographics, intraoperative details, complications, and outcomes were recorded from the medical record. Permanent CN nerve injury was defined as deficits lasting >6 months. Frequency statistics, averages, chi-squared test, and multiple logistic regression were completed for primary end points of complications and disease-free survival. Patient-reported outcomes were gathered via telephone survey of patients conducted in September 2021. RESULTS Fifty-one patients presented with CBTs and the following Shamblin classes: I (n = 7; 14%), II (n = 36; 69%), and III (n = 9; 17%). Head and neck oncology and vascular surgery jointly did 52% of CBT resections, including 6 of 9 Shamblin III cases. Eight patients (15.3%, all Shamblin II or III) suffered a total of 12 CN injuries - 8 CN XII (5 temporary and 3 permanent), 3 CN X (all permanent), and 1 CN XI (permanent). Seven of the CN injury subgroup had preoperative embolization and 5 were joint oncology/vascular cases. In addition, 4 separate carotid injuries required repair. Notably, all patients had disease-free survival postoperatively at a mean follow-up of 6 months. Patient-reported outcomes obtained in 70.6% of patients 1 year or more from index operation demonstrated that two-thirds of patients live without any permanent functional deficits, and the majority of those with continued deficits rate the symptoms as daily but mild in severity. CONCLUSIONS In a series of complex CBT patients treated with preoperative embolization capabilities and multidisciplinary surgical approach, disease-free survival was achieved in all patients despite a high rate of iatrogenic CN injuries, most commonly CN XII. Patient-reported outcomes survey results indicate that injuries identified on clinical exam underreport patients' true postoperative CN deficits - especially branches of CN X. This data support the practice of aggressive primary resection of CBTs while providing guidance for expected functional outcomes due to CN injury risk.
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Affiliation(s)
- Ryan Gupta
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO.
| | - Gregory Dyba
- University of Colorado Anschutz School of Medicine, Aurora, CO
| | - Emily A Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO
| | - John Campana
- Division of Head and Neck Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO
| | - Mark Nehler
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO
| | - Rafael D Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado Anschutz School of Medicine, Aurora, CO
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10
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Wang J, Li Y, Cui J, Li S, Lv W, Yao C, Wang S. Retrospective analysis of carotid body tumor surgical management: roles of preoperative image investigation and preoperative embolization. Ann Vasc Surg 2023:S0890-5096(23)00122-X. [PMID: 36863490 DOI: 10.1016/j.avsg.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/14/2023] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To analyze the management of carotid body tumors (CBTs), particularly the use of preoperative embolization (EMB) and image features in minimizing surgical complications. BACKGROUND CBT surgery is a challenging procedure, and the role of EMB in CBT surgery has remained unclear. METHODS A total of 200 CBTs were identified among 184 medical records involving CBT surgery. Regression analysis was used to explore the prognostic predictors of cranial nerve deficit (CND), including image features. In addition, blood loss, operation times, and complication rates were compared between patients who had surgery only versus patients who had surgery along with preoperative EMB. RESULTS Overall, 96 males and 88 females were identified for inclusion in the study, with a median age of 37.0 years. Computed tomography angiography (CTA) showed the presence of a tiny gap adjacent to the encasement of carotid vessels, which could help minimize carotid arterial injury. High-lying tumors that encased the cranial nerve were usually managed with synchronous cranial nerve resection. Regression analysis revealed that the incidence of CND was positively associated with Shamblin Ⅲ, high-lying, and a maximal CBT diameter of ≥ 5cm. Among 146 EMB cases, two cases of intracranial arterial embolization occurred. No statistical difference was found between the EBM and Non-EBM groups in terms of bleeding volume, operation time, blood loss, blood transfusion requirement, stroke, and permanent CND. Subgroup analysis revealed that EMB decreased CND in Shamblin III and low-lying tumors. CONCLUSIONS CBT surgery should be performed with preoperative CTA to identify favorable factors for minimizing surgical complications. Shamblin Ⅲ or high-lying tumors, as well as CBT diameter, are predictors of permanent CND. EBM does not reduce blood loss or shorten operation time.
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Affiliation(s)
- Jinsong Wang
- Division of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Vascular Surgery, Guangdong Provincial People's Hospital, 106 ZhongShan Road 2, Guangzhou 510080, China
| | - Yonghui Li
- Division of Cardiovascular Surgery, the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiangxi Road, Guangzhou 510080, China
| | - Jin Cui
- Division of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Songqi Li
- Division of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Weiming Lv
- Division of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China; Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Chen Yao
- Division of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Shenming Wang
- Division of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, China.
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11
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Tabb JN, Maas JA, Earla BP, Fallon KB, McDonald AM, Dobelbower MC. Carotid body paraganglioma metastatic to spine causing cord compression: a case report. Diagn Pathol 2023; 18:31. [PMID: 36829189 PMCID: PMC9951469 DOI: 10.1186/s13000-023-01314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Carotid body tumors (CBTs) are rare neuroendocrine neoplasms arising near the carotid bifurcation with a reported incidence of 1 to 2 cases in 100,000 patients. Most CBTs are sporadic, benign, slow-growing, and non-secreting, but untreated CBTs can grow locally to compress the nearby blood vessels, esophagus, and airway. Regional metastases can occur in 5% to 10% of cases, but distant metastases are exceedingly rare, occurring in roughly 1-2% of cases. As such, the optimal treatment for metastatic CBTs is not well-defined. We report a rare case of a patient with CBT distant metastases causing spinal cord compression. CASE PRESENTATION A 40-year-old African American female presented with a right neck mass, headaches, vertigo, tinnitus, hoarseness, and dysphagia. Imaging demonstrated a Shamblin II right neck mass; subsequent transcervical resection and pathology showed a carotid body paraganglioma. The patient recurred locally near the carotid bifurcation, so she underwent Stereotactic Body Radiation Therapy to the recurrent right neck disease. She later re-presented with new onset bilateral lower extremity weakness, dysmetria, and numbness. She was found to have metastatic disease to the thoracic spine causing spinal cord compression. She underwent laminectomy, tumor resection, and posterior fixation followed by adjuvant radiation therapy. She was started on systemic therapy with sunitinib. She eventually progressed with metastatic disease to the right iliac bone, which was treated with palliative radiotherapy. Second line systemic therapy with capecitabine and temozolomide was started. At last follow up, the patient was asymptomatic with stable persistent disease. CONCLUSIONS Paragangliomas often exhibit a prolonged interval to the development of progression; locoregional recurrences or rare distant metastases have been reported to occur as many as 20 years from diagnosis. The natural course of CBTs in other cases as well as the present case call into question the idea that CBTs are truly benign; instead CBTs may be indolent tumors with metastatic potential. Treatment choices for CBTs include surgical resection, radiation therapy, and systemic therapy, though the optimal treatment regimen for metastatic CBTs is not well-defined. A more advanced understanding of CBT pathophysiology, disease classification, risk stratification, and treatment options is needed to improve outcomes for patients.
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Affiliation(s)
- Jazmyne N. Tabb
- grid.267153.40000 0000 9552 1255University of South Alabama College of Medicine, Mobile, USA
| | - Jared A. Maas
- grid.265892.20000000106344187Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
| | - Bhargav P. Earla
- grid.265892.20000000106344187UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Kenneth B. Fallon
- grid.265892.20000000106344187Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
| | - Andrew M. McDonald
- grid.265892.20000000106344187Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
| | - Michael C. Dobelbower
- grid.265892.20000000106344187Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
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12
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Ramos A, Carnevale JA, Majeed K, Kocharian G, Hussain I, Goldberg JL, Schwarz J, Kutler DI, Knopman J, Stieg P. Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients. J Neurosurg 2023; 138:95-103. [PMID: 35523262 DOI: 10.3171/2022.3.jns22136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. Although inherently vascular lesions, the role of preoperative embolization prior to resection remains controversial. In this report, the authors describe an institutional series of patients with CBT successfully treated via resection following preoperative embolization and compare the results in this series to previously reported outcomes in the treatment of CBT. METHODS All CBTs resected between 2013 and 2019 at a single institution were retrospectively identified. All patients had undergone preoperative embolization performed by interventional neuroradiologists, and all had been operated on by a combined team of cerebrovascular neurosurgeons and otolaryngology-head and neck surgeons. The clinical, radiographic, endovascular, and perioperative data were collected. All procedural complications were recorded. RESULTS Among 22 patients with CBT, 63.6% were female and the median age was 55.5 years at the time of surgery. The most common presenting symptoms included a palpable neck mass (59.1%) and voice changes (22.7%). The average tumor volume was 15.01 ± 14.41 cm3. Most of the CBTs were Shamblin group 2 (95.5%). Blood was predominantly supplied from branches of the ascending pharyngeal artery, with an average of 2 vascular pedicles (range 1-4). Fifty percent of the tumors were embolized with more than one material: polyvinyl alcohol, 95.5%; Onyx, 50.0%; and N-butyl cyanoacrylate glue, 9.1%. The average reduction in tumor blush following embolization was 83% (range 40%-95%). No embolization procedural complications occurred. All resections were performed within 30 hours of embolization. The average operative time was 173.9 minutes, average estimated blood loss was 151.8 ml, and median length of hospital stay was 4 days. The rate of permanent postoperative complications was 0%; 2 patients experienced transient hoarseness, and 1 patient had medical complications related to alcohol withdrawal. CONCLUSIONS This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT at the authors' institution rests on a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and ear, nose, and throat-head and neck surgeons work together to optimally manage each patient with CBT.
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Affiliation(s)
- Alexander Ramos
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Joseph A Carnevale
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | | | - Gary Kocharian
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | | | | | - Justin Schwarz
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | | | - Jared Knopman
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Degollado-García J, Medina-Pizarro M, Cano-Velazquez G, Balcázar-Padrón JC, Gutierrez-Avila O, Nathal E. Microsurgical treatment of carotid body tumors using periadventitial dissection: Analysis of outcomes and prognostic factors in a neurological referral center. Surg Neurol Int 2022; 13:487. [DOI: 10.25259/sni_572_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Surgical resection for carotid body tumors (CBTs) is the gold standard of treatment and continues to be a challenging procedure, commonly associated with high vascular injury rates and neurological complications.
Methods:
It is a retrospective case series study between January 2002 and November 2020, with a mean follow-up of 29 months in a single nationwide referral center. Thirty-one patients diagnosed with a carotid body tumor and treated with microsurgical periadventitial resection were included in the study. Patients’ demographics, comorbidities, clinical, radiological factors, and tumor grade, evaluated by the Shamblin scale, were obtained. Statistical analysis was performed on all collected data.
Results:
In this study, we included 31 patients (32 tumors), 80% of the patients were female, and 20% were male, with a mean age of 53 years. One patient presented with bilateral lesions, while 17 tumors were located on the left side. The most frequent symptom was a painless, slow-growing neck mass in 74% of patients. Using the Shamblin classification, 13% of tumors were Grade I, 53% Grade II, and 34% Grade III. In the postoperative period, 3% of patients presented with permanent cranial nerve deficit, while none had vascular injuries or postoperative stroke. A tumor >5 cm increased the risk for nerve lesion by 11 times (OR 12.6, CI 95% 7.4-11.4, P < 0.001).
Conclusion:
Preoperative embolization followed by periadventitial resection by means of a microsurgical technique is a safe and effective approach to remove CBT, with 3% cranial nerve injury rate and no need for vascular sacrifice or reconstruction.
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Affiliation(s)
- Javier Degollado-García
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Mauricio Medina-Pizarro
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, United States,
| | - Gerardo Cano-Velazquez
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Juan C. Balcázar-Padrón
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Oscar Gutierrez-Avila
- Department of Neurological Surgery, Hospital Civil de Guadalajara. Guadalajara City, Mexico
| | - Edgar Nathal
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
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14
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Gan L, Shen XD, Ren Y, Cui HX, Zhuang ZX. Diagnostic features and therapeutic strategies for malignant paraganglioma in a patient: A case report. World J Clin Cases 2022; 10:9834-9844. [PMID: 36186170 PMCID: PMC9516940 DOI: 10.12998/wjcc.v10.i27.9834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/01/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paragangliomas and extra-adrenal pheochromocytomas are uncommon neuroendocrine tumors with ubiquitous distribution. Malignant paraganglioma is a relatively rare entity. We report the treatment and pathological characteristics of a patient with malignant paraganglioma, and summarize the latest advances in the treatment of malignant paraganglioma based on a literature review.
CASE SUMMARY A 45-year-old Chinese woman presented to the hospital due to pain in the waist (right side) and right buttock, and was diagnosed as malignant paraganglioma after the placement of ureteral stent, implantation of ileus catheter, and transvaginal removal of the vaginal mass. After relief of intestinal obstruction, the patient received intravenous chemotherapy and peritoneal perfusion chemotherapy. Although her pelvic mass disease was stable, she developed multiple liver metastases and bone metastases. Due to the development of spinal cord compression, she underwent orthopedic surgery, followed by radiotherapy, and molecular targeted therapy with apatinib, but with poor disease control.
CONCLUSION Clinical management of paraganglioma is challenging for endocrinologists and oncologists. Prospective studies are required to develop standardized therapeutic strategies for malignant paragangliomas.
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Affiliation(s)
- Lei Gan
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Xu-Dong Shen
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Yang Ren
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Hong-Xia Cui
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Zhi-Xiang Zhuang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
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15
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Fink-Josephi G, Hurtado-López LM, Hernández-Valencia AF, Higuera-Calleja JA, Guerrero-Avendaño G. Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors. Head Neck 2022; 44:2803-2809. [PMID: 36129095 DOI: 10.1002/hed.27190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/24/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.
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Affiliation(s)
| | | | | | | | - Guadalupe Guerrero-Avendaño
- Neurosurgery Service, Hospital General de México, Mexico City, Mexico.,Interventional Radiology Service, Hospital General de México, Mexico city, Mexico
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16
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Ejaz S, Nandam N, Maygarden S, Styner M. A Study of Paraganglioma Cases With Non-European Ancestry. Cureus 2022; 14:e27854. [PMID: 36110458 PMCID: PMC9462397 DOI: 10.7759/cureus.27854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
Capable of generating excess catecholamines, untreated extra-adrenal paragangliomas (PGLs) result in severe cardiovascular morbidity and mortality. Increasingly, a hereditary basis can be identified to underlie PGLs, though such data are largely absent in populations of non-European descent. We present two patients with PGL, both exhibiting similar age, sex, and geographic ancestry. Our patients are unrelated, Kinyarwanda-speaking females from the Democratic Republic of the Congo. The first patient presented with lower extremity edema and poorly controlled hypertension and was found to have multifocal PGL in the abdomen and bladder, proven by biopsy and treated with surgical excision. Our second patient presented with palpitations, shortness of breath, headache, and hypertension, was found to have mediastinal PGL, and underwent surgical excision. Genetic testing was negative in both cases. The first patient has not shown recurrence based on active surveillance with imaging and biochemical testing. There is a concern for recurrence in the second patient, eight years after diagnosis, which is currently being investigated. Our second patient lived at a high altitude for most of her life, pointing toward a possible role of hypoxia in the pathogenesis of her tumor development. Our cases raise questions that require active inquiry regarding additional environmental and/or genetic factors that might predispose to PGLs in uncommon anatomic sites and in understudied, vulnerable populations.
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17
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Gonzalez-Urquijo M, Castro-Varela A, Barrios-Ruiz A, Hinojosa-Gonzalez DE, Salas AKG, Morales EA, González-González M, Fabiani MA. Current trends in carotid body tumors: Comprehensive review. Head Neck 2022; 44:2316-2332. [PMID: 35838064 DOI: 10.1002/hed.27147] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. METHODS Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. RESULTS Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. CONCLUSION This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.
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Affiliation(s)
| | - Alejandra Castro-Varela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Alanna Barrios-Ruiz
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | | | - Ana Karen Garza Salas
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Erick Ambriz Morales
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Mirna González-González
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.,Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey, Nuevo León, Mexico
| | - Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
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18
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Lyle DA, Lopez A, Osofsky R, Wiemann B, Boyd N, Olson G, Rana MA. Outcomes of Carotid Body Tumor Management with Active Surveillance. Ann Otol Rhinol Laryngol 2022; 132:551-557. [PMID: 35723203 DOI: 10.1177/00034894221105833] [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: 11/16/2022]
Abstract
OBJECTIVES To assess outcomes of carotid body tumors (CBTs) managed with active surveillance. METHODS Retrospective chart review of CBTs managed with active surveillance from 2001 to 2019. RESULTS A total of 115 cases were identified during chart review. Sixty-five of these patients were managed with active surveillance, and 11 patients had bilateral tumors for a total of 76 tumors. Follow-up records with symptomatic outcomes were available for 51 patients, and 47 tumors had follow-up imaging. Thirty-one (66%) actively surveilled CBTs remained stable or decreased in size while 16 (34%) increased in size. Patients undergoing active surveillance developed symptoms in 12 cases, 6 of these patients underwent surgical intervention. Nine CBTs managed with active surveillance (18%) were ultimately resected. The majority of patients who did not undergo surgical intervention never developed symptoms (36/42, 86%). CONCLUSIONS Active surveillance may be a reasonable approach for a subset of CBTs.
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Affiliation(s)
- Daniel A Lyle
- School of Medicine, University of New Mexico School of Medicine MSC08 4720, Albuquerque, NM, USA
| | - Alexis Lopez
- Division of Otolaryngology-Head and Neck Surgery, University of New Mexico School of Medicine MSC10 5610, Albuquerque, NM, USA
| | - Robin Osofsky
- Department of Surgery, University of New Mexico School of Medicine MSC08 4720, Albuquerque, NM, USA
| | - Brianne Wiemann
- Department of Surgery, University of New Mexico School of Medicine MSC08 4720, Albuquerque, NM, USA
| | - Nathan Boyd
- Division of Otolaryngology-Head and Neck Surgery, University of New Mexico School of Medicine MSC10 5610, Albuquerque, NM, USA
| | - Garth Olson
- Division of Otolaryngology-Head and Neck Surgery, University of New Mexico School of Medicine MSC10 5610, Albuquerque, NM, USA
| | - Muhammad Ali Rana
- Department of Surgery, University of New Mexico School of Medicine MSC08 4720, Albuquerque, NM, USA.,Division of Vascular Surgery, University of New Mexico School of Medicine MSC10 5610, Albuquerque, NM, USA
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19
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Wu Z, Qiu P, Pu H, Ye K, Liu G, Li W, Liu X, Yin M, Jiang M, Qin J, Lu X, Zhao Z. Efficacy and safety of preoperative embolization in carotid body tumor treatment: A propensity score matching retrospective cohort study. Head Neck 2022; 44:1414-1421. [PMID: 35319144 DOI: 10.1002/hed.27038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To assess the efficacy and safety of preoperative embolization (PE) in patients with carotid body tumor (CBTs). METHODS In a single-center retrospective cohort study, 127 patients underwent surgical resection of CBTs from January 2003 to December 2019. One-to-one propensity score matching was conducted between patients with or without PE. RESULTS Thirty-two (25.2%) patients received PE. After propensity score matching, no statistically significant differences were found in the baseline characteristics of 28 patients in each group. Compared with NPE group, operative time and estimated blood loss (EBL) were significantly reduced in the PE group. The incidence of stroke, perioperative complications, intraoperative blood transfusion, vascular reconstruction, hospital stay, tumor recurrence, and all-cause mortality were not different between the PE and NPE group. CONCLUSIONS Preoperative embolization was efficient and safe with a reduction of intraoperative blood loss and operative time during CBT resection.
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Affiliation(s)
- Zhaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Guang Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
| | - Zhen Zhao
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Vascular Center of Shanghai Jiaotong University, Shanghai, China
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20
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Youssef O, Bushra A, Meryem R, Yassir H, Khadija EB, Sami R, Redallah A, Mohamed R, Mohamed M. An unusual combined glomus vagale and jugular tumor: A case report. Ann Med Surg (Lond) 2021; 70:102918. [PMID: 34691440 PMCID: PMC8519800 DOI: 10.1016/j.amsu.2021.102918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/03/2021] [Accepted: 10/03/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. We report an unusual combined glomus vagal and jugular tumor that was rarely described in the literature to the best of our knowledge. Case presentation A 51 years old female with no pathological history was presented to our ENT department with 6 months’ history of a right latero cervical swelling gradually increasing in size associated with a swallowing difficulties and hoarseness. Preoperatively clinical examination had found vagal and hypoglossal nerve paralysis. Cervical CT scan and MRI had shown glomus jugular tumor. The patient underwent a surgical excision with severe swallowing difficulties and facial palsy in the immediate postoperative period with a mild recovery afterwards. Clinical discussion Paragangliomas of the mesotympanum and jugular foramen most commonly present as a vascular middle ear mass. The most common presenting symptom is pulsatile tinnitus occurring in 80% followed by hearing loss (60%). Dysfunction of cranial nerves traversing the jugular foramen may be commonly encountered with resultant abnormalities of speech, swallowing and airway function. Vagal paragangliomas are the least common of the three primary craniocervical paragangliomas. The most common presenting sign is the presence of a painless neck mass accompanied occasionally by dysphagia and hoarseness. The association of both glomus vagal and jugular tumor is rarely described in the literature to the best of our knowledge. Conclusion Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. Vagal paragangliomas are the least common of the three primary craniocervical paragangliomas. The association of both glomus vagal and jugular tumor is rarely described in the literature to the best of our knowledge. The choice of treatment depends on the location, size, and also biologic activity of the tumor as well as the physical condition of the patient. The combination of jugular tumor et glomus vagal is very rare in the literature to the best of our knowledge. The choice of treatment depends on the location, size, and also biologic activity of the tumor as well as the physical condition of the patient. Surgery can provide excellent control of the tumour while radiation therapy may be considered for patients with surgery contraindication. Facial nerve palsies and swallowing difficulty have been reported in the postoperative period in several cases.
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Affiliation(s)
- Oukessou Youssef
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abdulhakeem Bushra
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
- Corresponding author
| | - Regragui Meryem
- Pathology Department, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Hammouda Yassir
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - El Bouhmadi Khadija
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Rouadi Sami
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abada Redallah
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Roubal Mohamed
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mahtar Mohamed
- Department of Otolaryngology Head Neck Surgery, University Hospital Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
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21
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Borghese O, Ferrer C, Pisani A, Camaioni A, Giudice R. Shamblin III Chemodectoma: The vascular surgeon's point of view. JOURNAL DE MEDECINE VASCULAIRE 2021; 46:209-214. [PMID: 34862014 DOI: 10.1016/j.jdmv.2021.07.002] [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: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Chemodectomas (CBTs) are the most frequently encountered tumours at the carotid bifurcation. Even if rare and commonly benign, their development close to the head and neck structures is often source of morbidity by compression and infiltration. Therefore, in order to avoid permanent neurologic or vascular complications these infrequent lesions need to be early removed. The total excision may be technically challenging and requires extensive expertise in surgical neck anatomy and a cooperative multidisciplinary approach. Almost a quarter of CBTs infiltrate carotid vessels so vascular expertise is pivotal in their resection. The present study aims to give an overview of vascular specificity and procedures required during surgical excision of such tumors to assist and guide treating physicians who encounter CBTs. This overview will particularly emphasize current therapeutic options: we discuss the referral criteria that should guide the decision about what type of preoperative care and surgical procedure should be offered to the affected patients. We also specify the epidemiologic data, screening recommendations and outcomes achieved with the different therapeutic approaches. The clinical, operative and follow-up data about a case of a Shamblin III carotid body tumour surgically removed by a multidisciplinary team at our Institution are also reported.
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Affiliation(s)
- Ottavia Borghese
- Departement of Surgery Pietro Valdoni, University Sapienza, Viale del Policlinico, 00100 Rome, Italy.
| | - Ciro Ferrer
- Department of Vascular and Endovascular Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angelo Pisani
- Departement of Cardiac Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Angelo Camaioni
- Department of Head and Neck Surgery, San Giovanni-Addolorata Hospital, Rome (RM), Italy
| | - Rocco Giudice
- Department of Vascular and Endovascular Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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22
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Katagiri K, Shiga K, Ikeda A, Saito D, Oikawa SI, Tsuchida K, Miyaguchi J, Kusaka T, Tamura A, Nakayama M, Izumisawa M, Yoshida K, Ogasawara K, Takahashi F. The Influence of Young Age on Difficulties in the Surgical Resection of Carotid Body Tumors. Cancers (Basel) 2021; 13:cancers13184565. [PMID: 34572792 PMCID: PMC8465132 DOI: 10.3390/cancers13184565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary The aim of this study was to reveal the factors affecting the complexity and difficulties in performing surgery to resect carotid body tumors (CBTs). We analyzed 20 patients with 21 CBTs. We used the “same day surgery” procedure, including preoperative embolization of the feeding arteries in the morning and resection surgery in the afternoon of the same day. Four patients underwent resection of the carotid artery, followed by reconstruction. These four patients were between 18 to 23 years of age at the time of surgery. The mean blood loss and operative time in these patients differed significantly from those in older patients. These results indicated that young age may influence the difficulties faced in CBT surgery, resulting in an increased risk of carotid artery resection. The results obtained from our study could help surgeons safely and effectively perform resection surgery for CBTs. Abstract This study evaluated patient characteristics that affect the complexity and difficulties of performing surgery to resect carotid body tumors (CBTs). We retrospectively reviewed the medical records of 20 patients with 21 CBTs who were enrolled in the study. The median patient age was 46 years and the mean tumor diameter was 37.6 mm. The mean blood loss and operative time were 40.3 mL and 183 min, respectively. Four patients underwent resection of the carotid artery followed by reconstruction. These four patients were between 18 to 23 years of age at the time of surgery. The mean blood loss and operative time in these patients were 166 mL and 394 min, respectively, which differed significantly from those of older patients. Therefore, young age influenced the difficulties faced in surgical resection of CBT, with an increased risk of blood loss and carotid artery resection.
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Affiliation(s)
- Kartsunori Katagiri
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
- Correspondence: ; Tel.: +81-19-613-7111
| | - Aya Ikeda
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Daisuke Saito
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Shin-ichi Oikawa
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Kodai Tsuchida
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Jun Miyaguchi
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Takahiro Kusaka
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.K.); (A.I.); (D.S.); (S.-i.O.); (K.T.); (J.M.); (T.K.)
| | - Akio Tamura
- Department of Radiology, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (A.T.); (M.N.); (M.I.)
| | - Manabu Nakayama
- Department of Radiology, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (A.T.); (M.N.); (M.I.)
| | - Mitsuru Izumisawa
- Department of Radiology, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (A.T.); (M.N.); (M.I.)
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.Y.); (K.O.)
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan; (K.Y.); (K.O.)
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, Iwate Medical University School of Medicine, Yahaba, Morioka 028-3695, Iwate, Japan;
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23
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Tang H, Jiang X, Xue S, Fu W, Tang X, Guo D. Long-Term Surgical Outcomes of Carotid Body Tumors With Pathological Fibrosis: A Cohort Study. Front Oncol 2021; 11:684600. [PMID: 34350114 PMCID: PMC8327168 DOI: 10.3389/fonc.2021.684600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the surgical outcomes of carotid body tumor (CBT) with or without pathological fibrosis, and evaluate the associated factors of fibrous CBT (FCBT). Materials and Methods Paraffin-embedded tissues of 236 patients with unilateral CBTs at our center were retrospectively reviewed from January 2008 to May 2020. Based on the pathologic features, CBTs were divided into FCBT and conventional CBT (CCBT) groups. The clinical data and surgical outcomes of the two groups were compared. Results Of 236 patients, 53 had FCBT and 183 had CCBT. FCBTs showed higher vascular invasion (24.53%), marked pleomorphism (22.64%), internal carotid artery reconstruction (37.74%), estimated blood loss (559.62 cm3), and postoperative nerve injury (49.06%), with lower 10-year recurrence- (89.2%) and major adverse event-free survival (87.3%) compared to CCBTs. Nerve injury was correlated with the Shamblin grade; major adverse events and nerve injury were both correlated with pathological fibrosis. Conclusion Compared with CCBT, FCBT is prone to increased recurrence, metastasis, major adverse events, and nerve injury risk. Early surgical resection, routine excision of surrounding abnormal lymph nodes, and closer clinical surveillance in FCBT patients are recommended.
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Affiliation(s)
- Hanfei Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaolang Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Song Xue
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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24
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Iturriaga R, Alcayaga J, Chapleau MW, Somers VK. Carotid body chemoreceptors: physiology, pathology, and implications for health and disease. Physiol Rev 2021; 101:1177-1235. [PMID: 33570461 PMCID: PMC8526340 DOI: 10.1152/physrev.00039.2019] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The carotid body (CB) is the main peripheral chemoreceptor for arterial respiratory gases O2 and CO2 and pH, eliciting reflex ventilatory, cardiovascular, and humoral responses to maintain homeostasis. This review examines the fundamental biology underlying CB chemoreceptor function, its contribution to integrated physiological responses, and its role in maintaining health and potentiating disease. Emphasis is placed on 1) transduction mechanisms in chemoreceptor (type I) cells, highlighting the role played by the hypoxic inhibition of O2-dependent K+ channels and mitochondrial oxidative metabolism, and their modification by intracellular molecules and other ion channels; 2) synaptic mechanisms linking type I cells and petrosal nerve terminals, focusing on the role played by the main proposed transmitters and modulatory gases, and the participation of glial cells in regulation of the chemosensory process; 3) integrated reflex responses to CB activation, emphasizing that the responses differ dramatically depending on the nature of the physiological, pathological, or environmental challenges, and the interactions of the chemoreceptor reflex with other reflexes in optimizing oxygen delivery to the tissues; and 4) the contribution of enhanced CB chemosensory discharge to autonomic and cardiorespiratory pathophysiology in obstructive sleep apnea, congestive heart failure, resistant hypertension, and metabolic diseases and how modulation of enhanced CB reactivity in disease conditions may attenuate pathophysiology.
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Affiliation(s)
- Rodrigo Iturriaga
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile, and Centro de Excelencia en Biomedicina de Magallanes, Universidad de Magallanes, Punta Arenas, Chile
| | - Julio Alcayaga
- Laboratorio de Fisiología Celular, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Mark W Chapleau
- Department of Internal Medicine, University of Iowa and Department of Veterans Affairs Medical Center, Iowa City, Iowa
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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25
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Sesti F, Feola T, Puliani G, Centello R, Di Vito V, Bagni O, Lenzi A, Isidori AM, Cantisani V, Faggiano A, Giannetta E. Sunitinib Treatment for Advanced Paraganglioma: Case Report of a Novel SDHD Gene Mutation Variant and Systematic Review of the Literature. Front Oncol 2021; 11:677983. [PMID: 34221997 PMCID: PMC8247584 DOI: 10.3389/fonc.2021.677983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Paragangliomas (PGLs) are neuroendocrine neoplasms arising from chromaffin cells of sympathetic or parasympathetic paraganglia. Systemic therapies have been used only in metastatic PGLs. Antiangiogenic agents, such as sunitinib, could be a viable therapeutic choice in the subgroup of patients with SDH-positive PGLs. We describe the case of a man with Familial Paraganglioma Syndrome type 1 (FPGL) related to a novel mutation in SDHD gene treated with sunitinib. Furthermore, we performed a systematic review of the literature aimed to address the following question: is sunitinib treatment effective in patients with advanced/progressive/metastatic PGL? Methods We performed a data search using MEDLINE, Cochrane Library, and Scopus between April 2019 and September 2020. We included studies reporting data on clinical or biological characteristics, or clinical outcomes of patients with PGLs treated with sunitinib. Results The search leaded to the selection of 25 publications. Data from case reports and case series showed that disease control rate (DCR = stable disease + partial response + complete response) was achieved in 34.7% of cases under sunitinib treatment. In 39% of patients DCR was followed by progressive disease (PD) or tumor relapse, 26.1% patients showed PD. Data from clinical trials showed that DCR was 83%, and the median progression free survival was 13.4 months. Discussion Data from the present literature review suggested that sunitinib could be a viable therapeutic option in advanced/progressive/metastatic inoperable PGLs. However, further trials on the efficacy of sunitinib in FPGL and sporadic PGL are needed.
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Affiliation(s)
- Franz Sesti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.,Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.,Oncological Endocrinology Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Roberta Centello
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Valentina Di Vito
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Oreste Bagni
- Radiology Unit, "Santa Maria Goretti" Hospital, Latina, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Pathological and Oncological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
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26
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Comparison of sedoanalgesia versus general anesthesia in surgical resection of carotid body tumors: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.904504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Osofsky R, Clark R, Das Gupta J, Boyd N, Olson G, Chavez L, Guliani S, Langsfeld M, Marek J, Rana MA. The effect of preoperative embolization on surgical outcomes for carotid body tumor resection. SAGE Open Med 2021; 9:20503121211005229. [PMID: 33854776 PMCID: PMC8013905 DOI: 10.1177/20503121211005229] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. Methods: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t-test and Fisher’s exact test. Results: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization (n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p < 0.001), operative time (337 ± 195 vs 199 ± 100 min, p = 0.004), and cranial nerve injuries overall (8 (40%) vs 2 (10%), p = 0.01) compared to patients undergoing resection without preoperative embolization (n = 29 (60%)). In subgroup analysis of Shamblin II/III classification tumors (n = 40), preoperative embolization (n = 18) was associated with increased tumor size (4.1 ± 0.6 vs 3.5 ± 0.9 cm, p = 0.01), operative time (351 ± 191 vs 244 ± 105 min, p = 0.02), and cranial nerve injury overall (8 (44%) vs 2 (9%), p = 0.03) compared to resections alone (n = 19). In further subgroup analysis of large (⩾ 3 cm) tumors (n = 37), preoperative embolization (n = 18) was associated with increased operative time (350 ± 191 vs 198 ± 99 min, p = 0.006) and cranial nerve injury overall (8 (44%) vs 2 (11%), p = 0.03) compared to resections alone (n = 19). There were no significant differences in estimated blood loss, transfusion requirement, or hematoma formation between any of the embolization and non-embolization subgroups. Conclusion: After controlling for tumor Shamblin classification and size, carotid body tumor resections following preoperative embolization were associated with increased operative time and inferior surgical outcomes compared to those tumors undergoing resection alone. Nonetheless, such results remain susceptible to the confounding effects of individual tumor characteristics often used in the decision to perform preoperative embolization, underscoring the need for prospective studies evaluating the utility of preoperative embolization for carotid body tumors.
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Affiliation(s)
- Robin Osofsky
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Ross Clark
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Nathan Boyd
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Garth Olson
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - LeAnn Chavez
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Sundeep Guliani
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Mark Langsfeld
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - John Marek
- School of Medicine, University of New Mexico, Albuquerque, NM, 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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Sudden Death Due to Neck Paraganglioma: A Pediatric Case Report and Review of the Literature. Am J Forensic Med Pathol 2021; 41:199-202. [PMID: 32735410 DOI: 10.1097/paf.0000000000000603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neck paragangliomas are relatively rare neuroendocrine nonsecretory tumors. They are mainly observed among adults and are often asymptomatic, causing a frequent delay in diagnosis. In pediatric cases, neck paragangliomas can be associated with adrenergic symptoms that may lead to complications.A report of a sudden death due to a carotid paraganglioma in a young girl is reported. Autopsy revealed a thoracic arotic dissection and a 4-cm jugulocarotidian mass in the absence of traumatic injuries. Histology showed no evidence of underlying aortic disease, including signs of Marfan syndrome, and a paraganglioma. Postmortem biochemistry analysis showed blood metanephrines levels 100 times higher than normal range. The cause of death was an aortic dissection complicating a neck paraganglioma. The manner of death was concluded as natural.Our case highlighted the importance for forensic pathologist to consider the diagnosis of paraganglioma in case of sudden hypertensive complications, especially among young people.
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Xing J, Cheng Y, Ying H, Guan M, Jia N, Bai C. Systemic treatment of a metastatic carotid body tumor: A case report and literature review. Medicine (Baltimore) 2020; 99:e22811. [PMID: 33217796 PMCID: PMC7676560 DOI: 10.1097/md.0000000000022811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Carotid body tumors (CBTs) are head and neck paragangliomas (PGLs) with a low incidence of distant metastasis. To date, only a few metastatic cases treated with detailed systemic therapy are reported and effective management is still inconclusive. Herein, we reported a metastatic CBT case with systemic therapy and reviewed the reported systemic treatment. PATIENT CONCERNS A 56-year-old man noticed multiple painless nodules on the right side of the neck and developed debilitating chest and back pain 7 years after the CBT resection. DIAGNOSES Widespread bone and lymph nodes CBT metastases. INTERVENTIONS Biopsies of the enlarged lymph nodes confirmed the diagnosis of metastatic CBT and 18F-FDG PET-CT detected multiple right cervical lymph nodes and bone metastases. 24 cycles of cyclophosphamide, vincristine and dacarbazine (CVD) chemotherapy were given since May 2016 to Jul 2018 and dacarbazine maintenance therapy was given in the next 15 months follow-up period. OUTCOMES Partial remission was achieved according to the Response Evaluation in Criteria in Solid Tumors 1.1 criteria. A prominent control in the metastatic lesions were also observed in 18F-FDG PET-CT scan. LESSONS Evidence for systemic management of metastatic CBTs is mainly based on studies of PGLs and pheochromocytoma. According to our review on metastatic CBT cases treated with systemic therapy from 1981 to 2018, chemotherapy, especially the CVD regimen, was a common reported management. In SDHB mutated patients, sunitinib and temozolomide could also be considered.
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Gözen ED, Tevetoğlu F, Kara S, Kızılkılıç O, Yener HM. Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center. EAR, NOSE & THROAT JOURNAL 2020; 101:NP180-NP185. [PMID: 32921153 DOI: 10.1177/0145561320957236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not. METHODS Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted. RESULTS A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class (r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors (r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury (r = -.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = -.64; P = .000). CONCLUSION Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.
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Affiliation(s)
- Emine Deniz Gözen
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Fırat Tevetoğlu
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Sinem Kara
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Osman Kızılkılıç
- Department of Radiology, 532719Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
| | - Haydar Murat Yener
- Department of Otorhinolaryngology, 64298Istanbul University-Cerrahpasa Medical Faculty, Fatih, İstanbul, Turkey
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Wernick BD, Furlough CL, Patel U, Samant S, Hoel AW, Rodriguez HE, Tomita TT, Eskandari MK. Contemporary management of carotid body tumors in a Midwestern academic center. Surgery 2020; 169:700-704. [PMID: 32868107 DOI: 10.1016/j.surg.2020.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Carotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection. METHODS A single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX). RESULTS Among 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21-79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1-9 days). At a mean follow-up of 12 months (range 1-63 months), there has been no recurrence. CONCLUSION Although carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.
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Affiliation(s)
- Brian Daniel Wernick
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Courtney L Furlough
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Urjeet Patel
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sandeep Samant
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tadaki T Tomita
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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COBANOGLU H, ARSLAN S, BAHADIR O, IŞIK Ü, İMAMOGLU M. Carotid body tumors: what have we learned in 5 years? ENT UPDATES 2020. [DOI: 10.32448/entupdates.708851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lozano FS, Muñoz A, de Las Heras JA, González-Porras JR. Simple and complex carotid paragangliomas. Three decades of experience and literature review. Head Neck 2020; 42:3538-3550. [PMID: 32812684 DOI: 10.1002/hed.26421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. METHODS Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. RESULTS Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. CONCLUSIONS Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.
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Affiliation(s)
- Francisco S Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Angel Muñoz
- Department of Otorhinolaryngology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José A de Las Heras
- Department of Radiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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Clinical Outcome of Carotid Body Paraganglioma Management: A Review of 10-Year Experience. JOURNAL OF ONCOLOGY 2020; 2020:6081273. [PMID: 32765605 PMCID: PMC7387983 DOI: 10.1155/2020/6081273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/21/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Abstract
Background Carotid body paragangliomas are rare neoplasms usually benign, however sometimes presenting as highly aggressive tumors. Surgery is the main line of treatment. Purpose To study and describe clinical presentations, surgical approaches, postoperative complications, and treatment outcomes. Materials and Methods A single-institution retrospective analysis of 19 cases with carotid body paragangliomas who were candidates for surgery from January 2009 through January 2019 with a mean follow-up period of 58.8 months. Results The mean age was 46 years with the female predominance of 63%. The mean size of the tumor was 4.3 cm. All cases were presented with a painless pulsating neck lump located anteriorly at the level of the hyoid bone. Neck US was done in all cases as a primary screening investigation. CT scanning was the second main investigation performed in 17 cases (89.5%) revealing tumors attached to the carotid artery at its bifurcation. Urinary catecholamine metabolites were measured in all cases to rule out familial functioning types. 5 cases (26.3%) were malignant. All cases were surgically approached through transcervical transverse incision. 11, 5, and 3 cases were classified as Shamblin's type II, III, and I, respectively. All tumors were R0 resected with nodal neck dissection conducted in the malignant group. Major complications occurred in 4 cases (21%) during tumor dissection from the adventitia of carotid bifurcation. ECA ligation was performed in one case (5.3%). 2 patients (10.5%) suffered XII nerve paralysis. Carotid artery blowout occurred in one patient (5.3%) and was immediately controlled. No operative mortality occurred. All patients were free of disease during the follow-up period. 4 malignant cases (21%) suffered a systemic relapse to bone and lung metastasis justifying adjuvant chemotherapy, radiotherapy, or both. Conclusions Surgery is the treatment of choice for carotid body paragangliomas. Complete R0 resection should be justified especially in case of malignancy. Adjuvant chemotherapy or radiotherapy is an option for patients with primary malignancy or relapse.
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Cass ND, Schopper MA, Lubin JA, Fishbein L, Gubbels SP. The Changing Paradigm of Head and Neck Paragangliomas: What Every Otolaryngologist Needs to Know. Ann Otol Rhinol Laryngol 2020; 129:1135-1143. [PMID: 32486832 DOI: 10.1177/0003489420931540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recommendations regarding head and neck paragangliomas (HNPGL) have undergone a fundamental reorientation in the last decade as a result of increased understanding of the genetic and pathophysiologic basis of these disorders. OBJECTIVE We aim to provide an overview of HNPGL and recent discoveries regarding their molecular genetics, along with updated recommendations on workup, treatment, and surveillance, and their implications for otolaryngologists treating patients with these disorders. RESULTS SDHx susceptibility gene mutations, encoding subunits of the enzyme succinate dehydrogenase (SDH), give rise to the Hereditary Pheochromocytoma/Paraganglioma Syndromes. SDHA, SDHB, SDHC, SDHD, and SDHAF2 mutations each result in unique phenotypes with distinct penetrance and risk for variable tumor development as well as metastasis. Genetic and biochemical testing is recommended for every patient with HNPGL. Multifocal disease should be managed in multi-disciplinary fashion. Patients with SDHx mutations require frequent biochemical screening and whole-body imaging, as well as lifelong follow-up with an expert in hereditary pheochromocytoma and paraganglioma syndromes. CONCLUSION Otolaryngologists are likely to encounter patients with HNPGL. Keeping abreast of the latest recommendations, especially regarding genetic testing, workup for additional tumors, multi-disciplinary approach to care, and need for lifelong surveillance, will help otolaryngologists appropriately care for these patients.
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Affiliation(s)
- Nathan D Cass
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa A Schopper
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Lauren Fishbein
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel P Gubbels
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
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Sevil FC. Management and outcomes of vascular reconstruction in carotid body tumor resection: retrospective analysis of 60 cases. Eur Arch Otorhinolaryngol 2020; 277:2299-2306. [PMID: 32335710 DOI: 10.1007/s00405-020-05975-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Carotid body tumors (CBTs) are rare tumors of the head and neck area. We evaluated outcomes after carotid body tumor resection (CBR) requiring vascular reconstruction. METHODS We retrospectively reviewed the patients, who underwent CBR in our clinic. Medical records were retrospectively reviewed for clinical data, operative details, Shamblin's classification, complications. Comparisons were performed between those undergoing CBR alone and CBR requiring vascular reconstruction (CBR-VASC). RESULTS Of the 60 patients, who underwent CBR, 29 (48.3%) underwent vascular reconstruction after the tumor resection. In patients; who underwent carotid endarterectomy and reconstruction of a kinked carotid artery, the blood flow measurements obtained before and after the vascular reconstruction were significantly different. The blood flow measurement parameters obtained before and after the vascular reconstruction were not significantly different in patients undergoing primary repair surgery, patch graft angioplasty, and the use of reversed saphenous vein graft procedures. The overall complication rate was 25% (n = 60) for at least one perioperative problem (CBR 6.4% vs. CBR-VASC 44.8%, p > 0.05). While most patients with Shamblin's class I and II tumors underwent CBR, CBR-VASC was performed more frequently in patients with Shamblin's class III tumors (p = 0.016). The tumor size ( p = 0.016), the volume of intraoperative blood loss (p = 0.002), and the length of hospital stay (p = 0.006) were significantly different between the two groups. The length of the operation time (p = 0.154) and the volume of the postoperative blood drainage (p = 0.122) were not different between the two groups. CONCLUSION The decision for surgical reconstruction should be made by evaluating the carotid artery blood flow before and after CBR. The type of the reconstruction method does not cause differences in the duration of the surgery and does not elevate the complication rates.
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Affiliation(s)
- Fehim Can Sevil
- Department of Cardiovascular Surgery, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey.
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Melachuri S, Valappil B, Snyderman C. Variations in Surgical Outcomes of Carotid Body Tumors by Surgical Specialty. Laryngoscope 2020; 131:E190-E195. [PMID: 32311766 DOI: 10.1002/lary.28688] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS A carotid body tumor (CBT) is a rare type of tumor that is divided among multiple surgical specialties. Individual surgeons may have limited experience in treating these tumors. We aim to compare different surgical specialties within a single healthcare system to detect variations in management and outcome. STUDY DESIGN Retrospective chart review. METHODS A chart review of all patients who underwent surgery for CBT at the University of Pittsburgh Medical Center (UPMC) from 2000 to 2019 was carried out. Univariate and multivariate analysis was used for descriptive statistics, comparison of outcomes, and identification of risk factors. RESULTS Fifty-eight CBT resection surgeries were performed at UPMC. Patients with advanced tumor were 6.7 (95% confidence interval [CI]: 1.36-32.7) times more likely to undergo preoperative embolization and 8.53 (95% CI: 2.011-36.19) times more likely to sustain carotid artery injury. Advanced-stage tumor resections were associated with greater blood loss (P = .03) and longer hospitalization (P = .02). Collaborative surgeries were associated with higher rates of carotid artery injury (P = .003), residual tumor (P < .001), and longer hospitalization (P = .003), as these combined cases were generally reserved for advanced-stage tumors (P = .02). There were no differences in outcomes between specialties. Of 22 surgeons, the median number of surgeries per surgeon was one (range = 1-12, 54.5%). CONCLUSIONS Surgeons who completed only one surgery for CBT had a greater rate of hospital readmission and greater length of hospital stay. Collaborative surgeries had worse outcomes due to more advanced tumors requiring more complex surgeries. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E190-E195, 2021.
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Affiliation(s)
- Samyuktha Melachuri
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Benita Valappil
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Sevil FC, Tort M, Kaygin MA. Carotid Body Tumor Resection: Long-Term Outcome of 67 Cases without Preoperative Embolization. Ann Vasc Surg 2020; 67:200-207. [PMID: 32234392 DOI: 10.1016/j.avsg.2020.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Carotid body tumors (CBTs) are rare tumors in the neck. Surgical resection is the gold standard of treatment. Surgical resection may be complicated by bleeding. Preoperative embolization has recently been introduced for the treatment to reduce the quantity of blood loss; however, the outcomes of this procedure are still under debate. In this article, we have presented the outcomes of patients who underwent surgical resection for CBT without undergoing preoperative embolization in our institution. METHODS This retrospective study reviewed 67 tumor resection cases who underwent surgical resection for CBTs without undergoing preoperative embolization. Tumor classification was performed as per the Shamblin classification. The demographic, clinical characteristics, and the operative information about the patients were retrieved from the patient records. The obtained data were analyzed with descriptive statistics. RESULTS The study included 12 male and 55 female patients. The mean age was 51.95 ± 16.59 years. Of the surgically resected tumors; 11 (16.4%) were Shamblin type I, 30 (44.8%) were Shamblin type II, and 26 (38.8%) were Shamblin type III. The mean duration of operation was 109.10 ± 32.36 min. The volume of intraoperative blood loss in the Shamblin type I, type II, and type III groups were 98.64 ± 23.46 cc, 215.33 ± 75.74 cc, and 351.73 ± 62.51 cc, respectively, and they were significantly different among the groups (P < 0.001). The volume of postoperative blood loss in the Shamblin type I, type II, and type III groups were 34.09 ± 10.44 cc, 53.00 ± 20.02 cc, and 62.50 ± 25.11 cc, respectively, and they were significantly different among the groups (P = 0.003). Cranial nerve injury developed in 10 (15.0%) patients. Postoperative stroke developed in 2 (3%) patients. No mortality or persistent nerve injury was observed in association with the injury in the patients during the 1-year follow-up period. CONCLUSIONS CBTs can be surgically resected safely and effectively without a need for preoperative embolization.
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Affiliation(s)
- Fehim Can Sevil
- Department of Cardiovascular Surgery, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey.
| | - Mehmet Tort
- Department of Cardiovascular Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mehmet Ali Kaygin
- Department of Cardiovascular Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Han T, Wang S, Wei X, Xie Y, Sun Y, Sun H, Zhu J, Wu Y, Zhou J, Zhao Z, Jing Z. Outcome of Surgical Treatment for Carotid Body Tumors in Different Shambling Type Without Preoperative Embolization: A Single-Center Retrospective Study. Ann Vasc Surg 2020; 63:325-331. [DOI: 10.1016/j.avsg.2019.08.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 12/16/2022]
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Chen Y, Li Y, Liu J, Yang L. The clinical characteristics and outcomes of carotid body tumors in Chinese patients: A STROBE-compliant observational study. Medicine (Baltimore) 2020; 99:e18824. [PMID: 32011493 PMCID: PMC7220344 DOI: 10.1097/md.0000000000018824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate the clinical characteristics and outcomes of carotid body tumors in Chinese patients in the last decade. A systematic search was conducted without limits and included studies published between January 2006 and December 2016 according to PubMed, the Chinese Science Citation Database, the China Science Periodical Database and the China National Knowledge Infrastructure. Relevant synonyms for the search terms "paraganglioma" and "carotid body tumor" were applied, and the clinical data were evaluated and analyzed. There were 1810 cases of CBTs reported in the last decade, of which females accounted for 60.22%, and the mean age was 40.60 years, with most cases being sporadic (98.51%). Surgical resection was performed in 1791 cases: vessel repair occurred in 38.88% of the cases, carotid ligation occurred in 1.42% of the cases, and 1.05% of the patients refused treatment. Some patients underwent selective embolization, and the results showed that embolization could decrease procedure time and blood loss (P < .01). Stroke and death occurred in 1.95% and 0.39% of patients, respectively. Malignant CBTs accounted for 4.30% of cases, and the metastatic sites involved were local metastasis (46.88%), lung (31.25%), bone (21.88%), liver (12.50%), and brain (9.38%). The overall survival rate was 98.87% 36 months after the procedure, and the survival rate of metastatic cases was 56.25% 6 months after recurrence; however, only 21.88% of metastatic cases received radiotherapy. The CBTs of Chinese patients showed some clinical features that were different from those of Western patients.
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Affiliation(s)
| | - Yanzi Li
- Department of Medical Administration
| | - Jianlin Liu
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Yang
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Butt N, Baek WK, Lachkar S, Iwanaga J, Mian A, Blaak C, Shah S, Griessenauer C, Tubbs RS, Loukas M. The carotid body and associated tumors: updated review with clinical/surgical significance. Br J Neurosurg 2019; 33:500-503. [PMID: 31130023 DOI: 10.1080/02688697.2019.1617404] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Purpose: The carotid body functions as a chemoreceptor and receives richer blood supply, by weight, than any other organ in the body. We review the literature regarding the anatomy, histology, and function of the carotid body and the incidence, functionality, and clinical relevance of carotid body tumors and paragangliomas. These lesions are often nonfunctional but can be associated with catecholamine secretion. Most patients are asymptomatic or present initially with a cervical mass. As the tumors grow, they can impinge on nearby cranial nerves. Although there is some debate, the dominant clinical strategy is to surgically resect these tumors as early as possible. If they are resected early, the risk of postoperative neurovascular injury is minimized. Methods: Literature search was performed using the PubMed database with focus on articles including descriptions of the carotid body and associated tumors. Results: We reviewed recent literature that related to the anatomy of the carotid body while also including carotid pargangliomas and associated diagnosis with treatment interventions. Conclusion: As the carotid body serves as a vital modulator of cardiovascular and respiratory functions, illustrates the importance of identifying potential carotid paragangliomas due its ability to impede function of the carotid body. By understanding carotid paraganglioma's distinct etiologies while also understanding proper diagnosis of tumors allows for early detection and appropriate treatment options.
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Affiliation(s)
- Nasir Butt
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
| | - Woong Kee Baek
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
| | - Stefan Lachkar
- Clinical Anatomy, Seattle Science Foundation , Seattle , WA , USA
| | - Joe Iwanaga
- Clinical Anatomy, Seattle Science Foundation , Seattle , WA , USA
| | - Asma Mian
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
| | - Christa Blaak
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
| | - Sameer Shah
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
- Clinical Anatomy, Seattle Science Foundation , Seattle , WA , USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University , St. George's, Grenada , West Indies
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Tokgöz SA, Saylam G, Bayır Ö, Keseroğlu K, Toptaş G, Çadallı Tatar E, Akın İ, Korkmaz MH. Glomus tumors of the head and neck: thirteen years' institutional experience and management. Acta Otolaryngol 2019; 139:930-933. [PMID: 31452413 DOI: 10.1080/00016489.2019.1655588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. Aims/objectives: This study aimed to express the safety of paraganglioma surgery regarding complications, treatment, and outcomes of patients with head and neck glomus tumors. Materials and methods: Medical records of patients who were operated because of head and neck paraganglioma between 2006 and 2016 were reviewed. Results: The study group consisted of 49 patients (M/F: 6/43). The patients were distributed as follows: 22 glomus caroticum (GC) (44.8%), 8 glomus jugulare (GJ) (16.3%), 10 glomus tympanicum (GT) (20.4%), 4 glomus vagale (GV) (8.1%), 2 GC + GV (4%), 2 bilateral GC (4%) and 1 thyroidal glomus tumor (2%). All GC and GV tumors were resected via cervical approach. Three of GJ tumors were resected through transmastoid approach while five of them were resected through both transmastoid and cervical approach. Nine GT tumors were resected via transmastoid approach. One patient received cyberknife. Thyroid paraganglioma was diagnosed incidentally after total thyroidectomy. Mean follow-up period was 61.92 ± 35.11 months (1-124 m). Conclusions and significance: The choice of treatment depends on the size, location and biologic activity of tumor as well as the physical condition of the patient. Our results show that glomus tumors can be resected with low mortality and morbidity rates due to developing imaging and microsurgical methods.
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Affiliation(s)
- Sibel Alicura Tokgöz
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ömer Bayır
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gökhan Toptaş
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - İstemihan Akın
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otorhinolaryngology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Texakalidis P, Charisis N, Giannopoulos S, Xenos D, Rangel-Castilla L, Tassiopoulos AK, Jabbour P, Grossberg JA, Machinis T. Role of Preoperative Embolization in Carotid Body Tumor Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 129:503-513.e2. [DOI: 10.1016/j.wneu.2019.05.209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
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Katagiri K, Shiga K, Ikeda A, Saito D, Oikawa S, Tshuchida K, Miyaguchi J, Tamura A, Nakasato T, Ehara S, Ishida K. Effective, same‐day preoperative embolization and surgical resection of carotid body tumors. Head Neck 2019; 41:3159-3167. [DOI: 10.1002/hed.25805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/21/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kartsunori Katagiri
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Kiyoto Shiga
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Aya Ikeda
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Daisuke Saito
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Shin‐ichi Oikawa
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Kodai Tshuchida
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Jun Miyaguchi
- Department of Head & Neck SurgeryIwate Medical University School of Medicine Morioka Iwate Japan
| | - Akio Tamura
- Department of RadiologyIwate Medical University School of Medicine Morioka Iwate Japan
| | - Tatsuhiko Nakasato
- Department of RadiologyIwate Medical University School of Medicine Morioka Iwate Japan
| | - Shigeru Ehara
- Department of RadiologyIwate Medical University School of Medicine Morioka Iwate Japan
| | - Kazuyuki Ishida
- Department of PathologyIwate Medical University School of Medicine Morioka Iwate Japan
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Carotid Paraganglioma in Adolescence-Clinical Picture-Surgical Technique and Review of the Literature. Case Rep Vasc Med 2019; 2019:6182783. [PMID: 30963018 PMCID: PMC6431431 DOI: 10.1155/2019/6182783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/31/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022] Open
Abstract
Paraganglia are clusters of cells originating from the neural crest with histological and cytochemical characteristics of neuroendocrine cells. Paragangliomas of the head and neck represent less than 0.5% of all head and neck tumors and they usually occur between the ages of 40 and 50. Paragangliomas in childhood and in adolescence are extremely rare; only 23 case reports have been reported in the recent literature. In childhood, the estimation of malignant potential is 3–10%; therefore, early diagnosis and treatment of carotid body paragangliomas are mandatory. However, due to the rarity of these lesions in young patients, they are often not included in the differential diagnosis of solid masses in the neck area, a fact that may lead to misdiagnosis or delay in treatment. We present, herein, two extremely rare cases of patients in adolescence who were diagnosed with a carotid body paraganglioma and were treated surgically in our unit. One of the patients was diagnosed and treated at the age of 15 years while the other had a long-standing tumor in the neck that was followed up by a general surgery outpatient service as a branchial cleft cyst at the age of 15 years and was eventually treated surgically 8 years later. Carotid body tumor was not considered in the initial differential diagnosis because of its rarity at this age range.
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Robertson V, Poli F, Hobson B, Saratzis A, Ross Naylor A. A Systematic Review and Meta-Analysis of the Presentation and Surgical Management of Patients With Carotid Body Tumours. Eur J Vasc Endovasc Surg 2019; 57:477-486. [PMID: 30902606 DOI: 10.1016/j.ejvs.2018.10.038] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/31/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS This is a systematic review and meta-analysis of 104 observational studies. RESULTS Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.
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Affiliation(s)
- Vaux Robertson
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | - Federica Poli
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | - Ben Hobson
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK
| | | | - A Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester UK.
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Prasad SC, Laus M, Al-Ghamdi S, Vashishth A, Piazza P, Sanna M. Update in the classification and the role of intra-arterial stenting in the management of carotid body paragangliomas. Head Neck 2019; 41:1379-1386. [PMID: 30771228 DOI: 10.1002/hed.25567] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra-arterial stenting in their surgical management. METHODS Retrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra-arterial stenting was performed in Shamblin II and II classes. RESULTS The mean follow-up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era. CONCLUSIONS The proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with arterial preservation.
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Affiliation(s)
| | - Melissa Laus
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Italy.,Department of ENT-Head & Neck Surgery, University of Chieti, Chieti, Italy
| | - Saeed Al-Ghamdi
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Italy
| | - Ashish Vashishth
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Italy
| | - Paolo Piazza
- Department of Neuroradiology, University-Hospital of Parma, Parma, Italy
| | - Mario Sanna
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Italy
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49
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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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50
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Jansen TTG, Marres HAM, Kaanders JHAM, Kunst HPM. A meta-analysis on the surgical management of paraganglioma of the carotid body per Shamblin class. Clin Otolaryngol 2018; 43:1104-1116. [PMID: 29656606 DOI: 10.1111/coa.13116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the risk associated with different types of surgery for carotid body paraganglioma of different Shamblin class. A meta-analysis was conducted to evaluate per tumour class, the local control, cranial nerve damage and complication rates of different techniques using internal carotid artery (ICA) and external carotid artery (ECA) ligation, clamping or bypassing, as well as the craniocaudal vs caudocranial techniques. DESIGN A meta-analysis is conducted after a systematic search in PubMed and the Cochrane library, in accordance with the PRISMA guidelines. MAIN OUTCOME MEASURES Local control, cranial nerve damage, complications, function recovery. RESULTS Out of 3565 articles, 27 were selected. The overall quality of evidence of studies was low. Cranial nerve damage (3%, 17% and 39%) and complication rates (0%, 1% and 10%) were significantly related to Shamblin class (class 1, 2 and 3, respectively, P < .01). For class 3 tumours, an increased risk of complications was found associated with routine ICA manipulation/reconstruction (RR 3.12 with a 95% CI of 1.29-7.59), as well as a trend towards enhanced risk of routine ECA ligation (RR 3.48 with a 95% CI of 0.88-13.81). CONCLUSIONS For class 1 and 2 tumours, surgery seems a viable treatment option. For class 3 tumours, morbidity in terms of cranial nerve deficit and complications is considerable; particularly, the use of ICA manipulation/reconstruction and potentially ECA ligation seem to be accompanied by high stroke incidence.
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Affiliation(s)
- T T G Jansen
- Department of Otolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H A M Marres
- Department of Otolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H P M Kunst
- Department of Otolaryngology and Head & Neck Surgery, Radboudumc Skull Base Centre, Radboud University Medical Center, Nijmegen, The Netherlands
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