1
|
Prospective evaluation of 68Ga-DOTANOC positron emission tomography/computed tomography and 131I-meta-iodobenzylguanidine single-photon emission computed tomography/computed tomography in extra-adrenal paragangliomas, including uncommon primary sites and to define their diagnostic roles in current scenario. Nucl Med Commun 2019; 40:1230-1242. [DOI: 10.1097/mnm.0000000000001096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
2
|
Dewan K, Shires CB. False Identity: Lymphoid Hyperplasia Imitating a Large Paraganglioma. Indian J Otolaryngol Head Neck Surg 2019; 71:790-794. [PMID: 31742065 DOI: 10.1007/s12070-018-1552-8] [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: 10/03/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
The danger of the parapharyngeal space mass comes from the small space and vital neighboring structures. Its differential diagnosis is broad, however benign lymphoid hyperplasia in this region has not been previously reported. The clinical presentation, imaging, surgical findings and pathology slides were reviewed in an adult patient with a parapharyngeal space mass. The literature on somatostatin-positive parapharyngeal space lesions was reviewed. A 51-year old male with otalgia for 3 months, hearing loss, and tinnitus underwent audiogram, revealing asymmetric hearing loss. Laryngoscopy demonstrated a paretic true vocal cord. Subsequent MRI demonstrated 4.5 cm post-styloid parapharyngeal space mass displacing the carotid artery anterolaterally. Octreoscan scan showed significant uptake of the somatostatin analog. Angiogram showed prominent vascular blush. The mass was excised transcervically and histopathology demonstrated lymphoid hyperplasia. This case demonstrates that post-styloid parapharyngeal masses may be lateral retropharyngeal nodes. An octreotide-positive lymphoid hyperplasia has never been previously reported.
Collapse
Affiliation(s)
- Karuna Dewan
- 1Department of Otolaryngology Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305 USA
| | - Courtney B Shires
- 2Department of Otolaryngology Head and Neck Surgery, The University of Tennessee Health Sciences Center, Memphis, TN USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Taïeb D, Hicks RJ, Hindié E, Guillet BA, Avram A, Ghedini P, Timmers HJ, Scott AT, Elojeimy S, Rubello D, Virgolini IJ, Fanti S, Balogova S, Pandit-Taskar N, Pacak K. European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 2019; 46:2112-2137. [PMID: 31254038 PMCID: PMC7446938 DOI: 10.1007/s00259-019-04398-1] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results. METHODS Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals. CONCLUSION Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (68Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (123I)/iodine-131 (131I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.
Collapse
Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 rue Saint-Pierre, 13005, Marseille Cedex 05, France.
| | - Rodney J Hicks
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Elif Hindié
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, Bordeaux University Hospitals, Pessac, France
| | - Benjamin A Guillet
- Department of Radiopharmacy, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Anca Avram
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Pietro Ghedini
- Nuclear Medicine Unit, Medicina Nucleare Metropolitana, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Henri J Timmers
- Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Saeed Elojeimy
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Transfusional Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Irène J Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefano Fanti
- Nuclear Medicine Unit, Medicina Nucleare Metropolitana, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Sona Balogova
- Department of Nuclear Medicine, Comenius University and St. Elisabeth Oncology Institute, Heydukova 10, 81250, Bratislava, Slovakia
- Department of Nuclear Medicine, Hôpital Tenon Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karel Pacak
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
5
|
Batchala PP, Dyer A, Mukherjee S, Rehm PK. Lateral ectopic thyroid mimics carotid body tumor on Indium-111 pentetreotide scintigraphy. Clin Imaging 2019; 58:46-49. [PMID: 31238185 DOI: 10.1016/j.clinimag.2019.05.012] [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] [Received: 02/22/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
A 34-year old woman with past history of anxiety, depression, and hypothyroidism resulting from prior total thyroidectomy for multinodular goiter presented with complaints of palpitations, sweating, and tachycardia. Clinical examination revealed a painless right lateral neck mass. USG/CT of the neck revealed the soft tissue mass located at the right carotid bifurcation. A subsequent Indium-111 pentetreotide somatostatin receptor scintigraphy (SRS) demonstrated tracer uptake in the mass. Hence, secretory carotid body tumor/paraganglioma was strongly suspected. However, post-surgical histopathological specimen revealed only benign thyroid follicles indicative of lateral ectopic thyroid with no evidence of neuroendocrine cells or malignancy. This case highlights the importance of considering lateral ectopic thyroid, a very rare entity, in the differential diagnosis for carotid bifurcation masses. Also highlighted is the false positivity from normal but ectopic thyroid tissue on Indium-111 pentetreotide SRS mimicking a paraganglioma.
Collapse
Affiliation(s)
- Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Anthony Dyer
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Patrice K Rehm
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
| |
Collapse
|
6
|
Novo Martínez G, del Blanco Alonso I, Santos Alcántara E, Rodríguez López I, Zorita Calvo A. Hipertensión arterial refractaria en paciente joven secundaria a tumor del cuerpo carotídeo bilateral productor de catecolaminas. ANGIOLOGIA 2018. [DOI: 10.1016/j.angio.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
7
|
Taïeb D, Wolf KI, Pacak K. Recent advances in the imaging of pheochromocytomas and paragangliomas. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017. [DOI: 10.2217/ije-2017-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytoma and paraganglioma (PPGL) belong to the family of neural crest cell-derived neoplasms, and can be widely distributed throughout the body. Over the past few years, with respect to these tumors, precision medicine has offered the promise of improved patient care. Through tumor visualization and identification of molecular signatures, nuclear medicine is capable of playing a key role in PPGL precision medicine. 68Ga-labeled somatostatin analogs were found to improve the detection and staging of head and neck paragangliomas, SDHx-related PPGLs and metastatic PPGLs regardless of genetic background. For PPGLs associated with increased kinase signaling or HIF2A mutations, 18F-fluorodihydroxyphenylalanine appears to be the most informative radiopharmaceutical. This review emphasizes the current theranostic approaches and future perspective related to PPGL imaging options.
Collapse
Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 13005 Marseille, France
| | - Katherine I Wolf
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
| |
Collapse
|
8
|
Vagal Paraganglioma Presenting as a Neck Mass Associated with Cough on Palpation. Case Rep Otolaryngol 2017; 2017:7603814. [PMID: 28717527 PMCID: PMC5498930 DOI: 10.1155/2017/7603814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022] Open
Abstract
A 70-year-old female presented with a neck mass and sporadic dry cough, often leading to fits of coughing severe enough to cause vomiting. The patient reported that touching the mass triggered the cough. On examination, a 2.5 cm right-sided level two neck mass deep to the sternocleidomastoid was present. Palpation of the mass immediately triggered coughing. Cross-sectional imaging proposed vagal paraganglioma as the chief differential, which was confirmed following surgical excision. The patient reported complete resolution of her severe dry cough after surgery. Vagal paragangliomas are rare neuroendocrine tumors arising from the neural crest-derived paraganglionic tissue surrounding the vagus nerve, typically presenting as a neck mass associated with hoarseness or pulsatile tinnitus. To the best of our knowledge this is a unique description in the English literature. This case is presented to aid physicians should they encounter a neck mass associated with cough. Vagal paraganglioma, although rare, should be part of the differential in such a presentation.
Collapse
|
9
|
Corrales CE, Fischbein N, Jackler RK. Imaging innovations in temporal bone disorders. Otolaryngol Clin North Am 2015; 48:263-80. [PMID: 25769351 DOI: 10.1016/j.otc.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The development of new imaging techniques coupled with new treatment algorithms has created new possibilities in treating temporal bone diseases. This article provides an overview of recent imaging innovations that can be applied to temporal bone diseases. Topics covered include the role of magnetic resonance (MR) diffusion-weighted imaging in cholesteatomas and skull base epidermoids, whole-body molecular imaging in paragangliomas of the jugular foramen, and MR arterial spin labeling perfusion for dural arteriovenous fistulas and arteriovenous malformations.
Collapse
Affiliation(s)
- C Eduardo Corrales
- Department of Otology, Neurotology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Nancy Fischbein
- Departments of Radiology, Otolaryngology-Head and Neck Surgery, Neurology, Neurosurgery and Radiation Oncology, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, CA 94305, USA
| | - Robert K Jackler
- Division of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
| |
Collapse
|
10
|
Abstract
Several classification systems for neuroendocrine tumors (NETs) exist, which use variable terminology and criteria for grading and staging. This variability in terminology can cause confusion and difficulty in recognizing which tumors are, in fact, members of this heterogeneous group of malignancies. The largest group of NETs, the gastroenteropancreatic NETs, has been well described and characterized; however, there are less-recognized extra-abdominal NETs that can arise from nearly any organ in the body. In this article, the clinical features and imaging appearances of the extra-abdominal NETs will be reviewed, compared, and contrasted. This diverse group consists of paragangliomas, Merkel cell carcinomas, esthesioneuroblastomas, NETs of the lung, and medullary thyroid carcinomas. Recognition of these tumors as part of the larger group of NETs is important for understanding how best to approach imaging for their diagnosis, staging, and potential treatment. Familiarity with the computed tomographic and magnetic resonance imaging appearances and the role of radionuclide imaging of these heterogeneous groups aids in the correct diagnosis and in treatment planning.
Collapse
|
11
|
Pirpiris A, Fu M, Budge J, Putnis S. Mesenteric paraganglioma: the case of mistaken identity. ANZ J Surg 2014; 87:312-313. [PMID: 25366582 DOI: 10.1111/ans.12905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Athina Pirpiris
- Colorectal Department, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Max Fu
- Colorectal Department, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Joel Budge
- Colorectal Department, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Soni Putnis
- Colorectal Department, Wollongong Hospital, Wollongong, New South Wales, Australia
| |
Collapse
|
12
|
Taïeb D, Kaliski A, Boedeker CC, Martucci V, Fojo T, Adler JR, Pacak K. Current approaches and recent developments in the management of head and neck paragangliomas. Endocr Rev 2014; 35:795-819. [PMID: 25033281 PMCID: PMC4167435 DOI: 10.1210/er.2014-1026] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors belonging to the family of pheochromocytoma/paraganglioma neoplasms. Despite advances in understanding the pathogenesis of these tumors, the growth potential and clinical outcome of individual cases remains largely unpredictable. Over several decades, surgical resection has long been the treatment of choice for HNPGLs. However, increasing experience in various forms of radiosurgery has been reported to result in curative-like outcomes, even for tumors localized in the most inaccessible anatomical areas. The emergence of such new therapies challenges the traditional paradigm for the management of HNPGLs. This review will assist and guide physicians who encounter patients with such tumors, either from a diagnostic or therapeutic standpoint. This review will also particularly emphasize current and emerging knowledge in genetics, imaging, and therapeutic options as well as the health-related quality of life for patients with HNPGLs.
Collapse
Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine (D.T.), La Timone University Hospital, CERIMED, Aix-Marseille Univ, F-13385 Marseille, France; Department of Radiation Oncology (A.K.), Besançon University Hospital, F-25030 Besançon, France; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), HELIOS Hanseklinikum Stralsund, D-18435 Stralsund, Germany; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), University Hospital, Freiburg, Germany; Program in Reproductive and Adult Endocrinology (V.M., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development and Medical Oncology Branch (T.F.), National Institutes of Health, Bethesda, Maryland 20892; Department of Neurosurgery (J.R.A.), Stanford Hospital and Clinics, Stanford University, Stanford, California 94305
| | | | | | | | | | | | | |
Collapse
|
13
|
Wong KK, Fig LM, Youssef E, Ferretti A, Rubello D, Gross MD. Endocrine scintigraphy with hybrid SPECT/CT. Endocr Rev 2014; 35:717-46. [PMID: 24977318 DOI: 10.1210/er.2013-1030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.
Collapse
Affiliation(s)
- Ka Kit Wong
- Nuclear Medicine/Radiology Department (K.K.W., E.Y., M.D.G.), University of Michigan Hospital, Ann Arbor, Michigan 48109; Nuclear Medicine Service (K.K.W., L.M.F., M.D.G.), Department of Veterans Affairs Health System, Ann Arbor, Michigan 48105; and Department of Nuclear Medicine (A.F., D.R.), Radiology, Medical Physics, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy
| | | | | | | | | | | |
Collapse
|
14
|
Complex glomus jugulare tumor: management issues. Indian J Otolaryngol Head Neck Surg 2014; 65:676-81. [PMID: 24427738 DOI: 10.1007/s12070-011-0399-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 11/24/2011] [Indexed: 10/14/2022] Open
Abstract
Glomus tumors are rare and locally aggressive, vascular paragangliomas of the skull base. Tumors may progress to cause lower cranial nerve palsies and involve the major vascular structure in the skull base, and thus pose very difficult surgical challenges. One such case is presented, the management problems in such "complex glomus jugulare" tumors are discussed, and the literature reviewed.
Collapse
|
15
|
Taïeb D, Varoquaux A, Chen CC, Pacak K. Current and future trends in the anatomical and functional imaging of head and neck paragangliomas. Semin Nucl Med 2013; 43:462-73. [PMID: 24094713 PMCID: PMC3792493 DOI: 10.1053/j.semnuclmed.2013.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Head and neck paragangliomas (HNPGLs) account for approximately 3% of all paragangliomas (PGLs). Most often, HNPGLs are benign, nonsecreting, and slowly progressing. The initial physical examination and biochemical diagnosis usually adds very little to the proper diagnosis of these tumors, and, therefore, radiologists and nuclear medicine physicians play a pivotal role in providing the initial diagnosis, the locoregional staging, and the plan for detecting potential multicentric or metastatic lesions. Based on several current studies, the most accurate use of HNPGL-specific initial and subsequent imaging modalities must be guided by the knowledge of genetics and the specifically measured biochemical profile of these tumors for the proper management of these patients. Thus, this short review article presents the application of the most up-to-date anatomical and functional imaging approaches to HNPGLs tightly linked to the clinical management of these patients. Based on the most recent studies, 18F-FDOPA PET/CT has been shown to be a useful addition to anatomical imaging in the preoperative localization and molecular assessment of HNPGLs. It is estimated that the frequency of metabolically active PGLs on 18F-FDOPA PET/CT in this region is higher than 90%. For patients with hereditary PGL syndromes, (18)F-FDG-PET/CT should be reserved. Imaging of somatostatin receptors using Octreoscan or 68Ga-labeled somatostatin analogues plays an important role for selecting patients for targeted radiation therapy. This review also concludes that it is expected that in the near future, these patients will indeed benefit from new diagnostic approaches based on the identification of new targets by molecular profiling studies that will result in the development of novel PGL-specific radiopharmaceuticals.
Collapse
Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille Univ, Marseille, France. Phone: +33-4-91-38-55-58, Fax: +33-4-91-38-47-69,
| | - Arthur Varoquaux
- Department of Radiology, La Timone University Hospital, Aix-Marseille Univ, Marseille, France. Phone: +33-4-91-38-56-75, Fax: +33-4-91-38-58-88,
| | - Clara C Chen
- Nuclear Medicine, Department of Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA. Phone: (301) 496-5675, Fax: (301) 496-0114,
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
16
|
Utilidad de la gammagrafía de receptores de somatostatina en la detección de recurrencias y seguimiento de paragangliomas carotídeos. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2013.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
17
|
Taïeb D, Timmers HJ, Hindié E, Guillet BA, Neumann HP, Walz MK, Opocher G, de Herder WW, Boedeker CC, de Krijger RR, Chiti A, Al-Nahhas A, Pacak K, Rubello D. EANM 2012 guidelines for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 2012; 39:1977-95. [PMID: 22926712 DOI: 10.1007/s00259-012-2215-8] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Radionuclide imaging of phaeochromocytomas (PCCs) and paragangliomas (PGLs) involves various functional imaging techniques and approaches for accurate diagnosis, staging and tumour characterization. The purpose of the present guidelines is to assist nuclear medicine practitioners in performing, interpreting and reporting the results of the currently available SPECT and PET imaging approaches. These guidelines are intended to present information specifically adapted to European practice. METHODS Guidelines from related fields, issued by the European Association of Nuclear Medicine and the Society of Nuclear Medicine, were taken into consideration and are partially integrated within this text. The same was applied to the relevant literature, and the final result was discussed with leading experts involved in the management of patients with PCC/PGL. The information provided should be viewed in the context of local conditions, laws and regulations. CONCLUSION Although several radionuclide imaging modalities are considered herein, considerable focus is given to PET imaging which offers high sensitivity targeted molecular imaging approaches.
Collapse
Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Parenti G, Zampetti B, Rapizzi E, Ercolino T, Giachè V, Mannelli M. Updated and new perspectives on diagnosis, prognosis, and therapy of malignant pheochromocytoma/paraganglioma. JOURNAL OF ONCOLOGY 2012; 2012:872713. [PMID: 22851969 PMCID: PMC3407645 DOI: 10.1155/2012/872713] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 06/05/2012] [Indexed: 12/31/2022]
Abstract
Malignant pheochromocytomas/paragangliomas are rare tumors with a poor prognosis. Malignancy is diagnosed by the development of metastases as evidenced by recurrences in sites normally devoid of chromaffin tissue. Histopathological, biochemical, molecular and genetic markers offer only information on potential risk of metastatic spread. Large size, extraadrenal location, dopamine secretion, SDHB mutations, a PASS score higher than 6, a high Ki-67 index are indexes for potential malignancy. Metastases can be present at first diagnosis or occur years after primary surgery. Measurement of plasma and/or urinary metanephrine, normetanephrine and metoxytyramine are recommended for biochemical diagnosis. Anatomical and functional imaging using different radionuclides are necessary for localization of tumor and metastases. Metastatic pheochromocytomas/paragangliomas is incurable. When possible, surgical debulking of primary tumor is recommended as well as surgical or radiosurgical removal of metastases. I-131-MIBG radiotherapy is the treatment of choice although results are limited. Chemotherapy is reserved to more advanced disease stages. Recent genetic studies have highlighted the main pathways involved in pheochromocytomas/paragangliomas pathogenesis thus suggesting the use of targeted therapy which, nevertheless, has still to be validated. Large cooperative studies on tissue specimens and clinical trials in large cohorts of patients are necessary to achieve better therapeutic tools and improve patient prognosis.
Collapse
Affiliation(s)
- Gabriele Parenti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Benedetta Zampetti
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Elena Rapizzi
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- Istituto Toscano Tumori, Via Taddeo Alderotti 26N, 50139 Florence, Italy
| | - Tonino Ercolino
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Valentino Giachè
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Massimo Mannelli
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- Istituto Toscano Tumori, Via Taddeo Alderotti 26N, 50139 Florence, Italy
| |
Collapse
|
19
|
Wong KK, Waterfield RT, Marzola MC, Scarsbrook AF, Chowdhury FU, Gross MD, Rubello D. Contemporary nuclear medicine imaging of neuroendocrine tumours. Clin Radiol 2012; 67:1035-50. [PMID: 22633086 DOI: 10.1016/j.crad.2012.03.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 03/02/2012] [Accepted: 03/12/2012] [Indexed: 12/31/2022]
Abstract
Neuroendocrine tumours (NETs) are rare, heterogeneous, and often hormonally active neoplasms. Nuclear medicine (NM) imaging using single photon- and positron-emitting radiopharmaceuticals allows sensitive and highly specific molecular imaging of NETs, complementary to anatomy-based techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI). Somatostatin-receptor scintigraphy is a whole-body imaging technique widely used for diagnosis, staging and restaging of NETs. The increasing availability of hybrid single-photon emission CT (SPECT)/CT cameras now offers superior accuracy for localization and functional characterization of NETs compared to traditional planar and SPECT imaging. The potential role of positron-emission tomography (PET) tracers in the functional imaging of NETs is also being increasingly recognized. In addition to 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG), newer positron-emitting radiopharmaceuticals such as (18)F-dihydroxyphenylalanine (DOPA) and (68)Ga-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) peptides, show promise for the future. This article will summarize the role of current and emerging radiopharmaceuticals in NM imaging of this rare but important group of tumours.
Collapse
Affiliation(s)
- K K Wong
- Nuclear Medicine, Radiology Department, University of Michigan Hospital, Ann Arbor, MI, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Pepe G, Moncayo R, Bombardieri E, Chiti A. Somatostatin receptor SPECT. Eur J Nucl Med Mol Imaging 2012; 39 Suppl 1:S41-51. [DOI: 10.1007/s00259-011-2019-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
21
|
Obholzer RJ, Hornigold R, Connor S, Gleeson MJ. Classification and management of cervical paragangliomas. Ann R Coll Surg Engl 2011; 93:596-602. [PMID: 22041235 DOI: 10.1308/147870811x13137608455172] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cervical paragangliomas are slow-growing tumours that eventually cause lower cranial nerve palsies and infiltrate the skull base. Surgical treatment may cause the same deficits and, in some, risks more serious neurological deficits. We describe a classification used to guide investigation, consent and management of cervical paragangliomas based on extensive experience. METHODS The case notes of patients managed by the senior author at a tertiary referral skull base unit between 1987 and 2010 were reviewed retrospectively. A total of 87 cervical paragangliomas were identified in 70 patients (mean age: 46 years, range: 13-77 years). Of these, 35 patients had 36 vagal paragangliomas, 43 patients had 50 carotid body paragangliomas and 8 had both. One cervical paraganglioma arose from neither the carotid body nor the nodose ganglion. The main outcome measures were death, stroke, gastrostomy and tracheotomy. RESULTS All tumours were classified pre-operatively based on their relationship to the carotid artery, skull base and lower cranial nerves. Type 1 tumours were excised with a transcervical approach, type 2 with a transcervical-parotid approach and type 3 with a combined transcervical-parotid and infratemporal fossa approach. Type 4 patients underwent careful assessment and genetic counselling before any treatment was undertaken. There were no peri-operative deaths; two patients had strokes, one required a long-term feeding gastrostomy and none required a tracheotomy. CONCLUSIONS The use of a pre-operative classification system guides management and surgical approach, improves accuracy of consent, facilitates audit and clarifies which patients should be referred to specialised centres.
Collapse
Affiliation(s)
- R J Obholzer
- Department of Otolaryngology, Guy's hospital, London SE1 9RT, UK.
| | | | | | | |
Collapse
|
22
|
Endocrine Disease. Perioper Med (Lond) 2011. [DOI: 10.1007/978-0-85729-498-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
23
|
Kataria T, Bisht SS, Mitra S, Abhishek A, Potharaju S, Chakarvarty D. Synchronous malignant vagal paraganglioma with contralateral carotid body paraganglioma treated by radiation therapy. Rare Tumors 2010; 2:e21. [PMID: 21139824 PMCID: PMC2994506 DOI: 10.4081/rt.2010.e21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 02/25/2009] [Accepted: 02/26/2010] [Indexed: 11/26/2022] Open
Abstract
Paragangliomas are rare tumors and very few cases of malignant vagal paraganglioma with synchronous carotid body paraganglioma have been reported. We report a case of a 20-year old male who presented with slow growing bilateral neck masses of eight years duration. He had symptoms of dysphagia to solids, occasional mouth breathing and hoarseness of voice. Fine needle aspiration cytology (FNAC) performed where he lived showed a sinus histiocytosis and he was administered anti-tubercular treatment for six months without any improvement in his symptoms. His physical examination revealed pulsatile, soft to firm, non-tender swellings over the anterolateral neck confined to the upper-mid jugulo-diagastric region on both sides. Direct laryngoscopy examination revealed a bulge on the posterior pharyngeal wall and another over the right lateral pharyngeal wall. Magnetic resonance imaging (MRI), 99mTc-labeled octreotide scan and angiography diagnosed the swellings as carotid body paraganglioma, stage III on the right side with left-sided vagal malignant paraganglioma. Surgery was ruled out as a high morbidity with additional risk to life was expected due to the highly vascular nature of the tumor. The patient was treated with radiation therapy by image guided radiation to a dose of 5040cGy in 28 fractions. At a follow-up at 16 months, the tumors have regressed bilaterally and the patient can take solids with ease.
Collapse
Affiliation(s)
- Tejinder Kataria
- Dept of Radiation Oncology, Medanta, The Medicity, Gurgaon, India
| | | | | | | | | | | |
Collapse
|
24
|
Ilias I, Pacak K. A clinical overview of pheochromocytomas/paragangliomas and carcinoid tumors. Nucl Med Biol 2009; 35 Suppl 1:S27-34. [PMID: 18707631 DOI: 10.1016/j.nucmedbio.2008.04.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 01/02/2023]
Abstract
Pheochromocytomas/paragangliomas are rare tumors; most are sporadic. Biochemical proof of disease is better with measurement of plasma metanephrines and less cumbersome than determinations in urine; its implementation is expanding. Anatomical imaging with computed tomography or magnetic resonance imaging should be followed by functional (nuclear medicine) imaging: chromaffin tumor-specific methods are preferred. Treatment is surgical; for nonoperable disease other options are available. Overall 5-year survival is 50%. Carcinoid tumors derive from serotonin-producing enterochromaffin cells in the fore-, mid- or hindgut. Biochemical screening (and follow-up) is done with measurements of 5-hydroxyindoloacetic acid in urine. For most carcinoids, functional imaging is better than other modalities in localizing primary tumors. Surgery is the treatment of choice; nonresectable tumors are treated with somatostatin analogs or chemotherapy. Overall 5-year survival for patients with carcinoids is 67%.
Collapse
Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, E. Venizelou Hospital, Athens GR-11521, Greece.
| | | |
Collapse
|
25
|
Fish JH, Klein-Weigel P, Biebl M, Janecke A, Tauscher T, Fraedrich G. Systematic screening and treatment evaluation of hereditary neck paragangliomas. Head Neck 2007; 29:864-73. [PMID: 17563904 DOI: 10.1002/hed.20638] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Familial paragangliomas of the neck are often bilateral and more aggressive than spontaneous forms. Tumors appear earlier (2nd-4th decade) often with diffuse, multifocal involvement. Without treatment, these tumors can lead to significant morbidity. Three families with succinate dehydrogenase subunit D (SDHD) germline mutations underwent clinical and genetic evaluation. Patients were screened using ultrasound and evaluated further with conventional and functional imaging. Tumors with a diameter >1.5 cm were surgically removed. Multicentric and bilateral tumors were detected in 9/13 (69%) and 8/13 (62%) patients, respectively. Surgical morbidity occurred in 64% of patients. Local recurrence was 57%, although this was lower in tumors with a diameter <2 cm. We recommend an algorithm for a systematic approach to the diagnosis, monitoring, and treatment of familial head and neck paragangliomas. Operative treatment in advanced stages often leads to unwanted morbidity, such that earlier detection and treatment of smaller tumors seems to be of benefit.
Collapse
Affiliation(s)
- John H Fish
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Tyrol, Austria.
| | | | | | | | | | | |
Collapse
|
26
|
Suárez C, Sevilla MA, Llorente JL. Temporal paragangliomas. Eur Arch Otorhinolaryngol 2007; 264:719-31. [PMID: 17333230 DOI: 10.1007/s00405-007-0267-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/22/2006] [Indexed: 10/23/2022]
Abstract
Temporal paragangliomas (PGL) are usually limited to the paraganglionar system with a sporadic or familial origin. Familial PGL have recently been shown to be associated with germline alterations in SDH group of genes, and occasionally are associated with a variety of genetic multisystemic disorders (von Hippel-Lindau disease, multiple endocrine neoplasia type 2 and neurofibromatosis type 1). Temporal bone PGL are normally located in the region of the jugular foramen and on the promontory along the Jacobson nerve. Occasionally, vagal PGL may reach the jugular foramen and behave as jugular PGL. Treatment of temporal PGL must be based on the biological behavior of the tumour, age and medical condition of the patient, location and size of the PGL, and potential for treatment induced morbidity. The main treatment modalities for PGL are surgery and radiation therapy. Patients with large temporal PGL whose resection would result in potentially disabling morbidity are often selected for radiation therapy or wait and scan policy. Small tympanic PGL where resection may be carried out with a low morbidity risk can be removed through an endomeatal tympanotomy. Jugular PGL limited to the infralabyrinthine region involving only the vertical segment of the ICA, can benefit of an extended facial recess approach, which allows a postoperative normal hearing and facial nerve function. For more extensive disease in the middle ear or around the ICA, external auditory canal preservation is not possible and some kind of facial nerve mobilization is required. Preservation of lower cranial nerves is facilitated by intrabulbar dissection, previous extradural ligation of the sigmoid sinus. Management of large intracranial involvement is controversial, although most authors advocate resection of the tumour in a single stage. Surgical control of the tumour can be expected in 70-85% of the patients and is clearly dependent on the tumour stage. Tumour size determines success in hearing and lower cranial nerves preservation.
Collapse
Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | | |
Collapse
|
27
|
Zapanti E, Ilias I. Pheochromocytoma: Physiopathologic Implications and Diagnostic Evaluation. Ann N Y Acad Sci 2006; 1088:346-60. [PMID: 17192579 DOI: 10.1196/annals.1366.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pheochromocytoma (PHEO) is a chromaffin cell tumor embryologically arising from the neural crest tissue. The dominant secretory products of PHEO are catecholamines: noradrenaline (norepinephrine), adrenaline (epinephrine), and to a lesser extent dopamine. In addition to catecholamines, PHEO cells also elaborate and release several neuropeptides and inflammatory cytokines which can exert intra-adrenal and extra-adrenal systemic effects and cause characteristic clinical syndromes. In a concise review we present the intra-adrenal and extra-adrenal pathophysiologic implications of PHEO and the nuclear medicine modalities that permit functional imaging of physiological processes and help localize these tumors. The specific pathways of synthesis, metabolism, and inactivation of catecholamines (of PHEOs and paragangliomas) can be used as means to develop suitable tracers for positron emission tomography (PET) ligands. In this review we focus on imaging with PET using [(18)F]-fluorodopamine, [(18)F]-fluorohydroxyphenylalanine, [(11)C]-epinephrine, or [(11)C]-hydroxyephedrine and examine how functional imaging can often complement traditional anatomical imaging modalities and other scintigraphic techniques.
Collapse
Affiliation(s)
- Evangelia Zapanti
- First Department of Endocrinology, Alexandra hospital, Athens, GR-11528, Greece.
| | | |
Collapse
|
28
|
Shulkin BL, Ilias I, Sisson JC, Pacak K. Current Trends in Functional Imaging of Pheochromocytomas and Paragangliomas. Ann N Y Acad Sci 2006; 1073:374-82. [PMID: 17102106 DOI: 10.1196/annals.1353.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Most pheochromocytomas/paragangliomas should be evaluated with anatomical imaging (computed tomography or magnetic resonance imaging) followed by functional imaging (nuclear medicine modalities). Functional imaging assures that the tumor is indeed a pheochromocytoma/paraganglioma and enables more thorough localization, especially detecting as many lesions as possible (in particular for metastatic disease). Functional imaging for pheochromocytomas/paragangliomas, can use radiolabeled ligands specific for pathways of synthesis, metabolism, and inactivation of catecholamines or nonspecific ligands. In an overview of the available nuclear medicine modalities, we summarize the accumulated experience and recommend when functional imaging should be applied to patients with pheochromocytoma/paraganglioma.
Collapse
Affiliation(s)
- Barry L Shulkin
- Division of Nuclear Medicine, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA, and Department of Pharmacology, Medical School, University of Patras, Rion, Greece
| | | | | | | |
Collapse
|
29
|
Suárez C, Rodrigo JP, Ferlito A, Cabanillas R, Shaha AR, Rinaldo A. Tumours of familial origin in the head and neck. Oral Oncol 2006; 42:965-78. [PMID: 16857415 DOI: 10.1016/j.oraloncology.2006.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 03/08/2006] [Indexed: 12/15/2022]
Abstract
Individuals with inherited cancer syndromes are at significant risk of developing both benign and malignant tumours as a result of a germline mutation in a specific tumour suppressor gene. Tumours of familial origin are a rare event in the head and neck but despite this, they deserve a growing interest. Familial paragangliomas are most of the time limited to the paraganglionar system, but also may be part of different syndromic associations. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis in the search of SDHB, SDHC and SDHD mutations in families of affected patients plays a front-line diagnostic role, leading to more efficient patient management. Multiple endocrine neoplasias type 1 are characterized by the simultaneous occurrence of at least two of the three main related endocrine tumours: parathyroid, enteropancreatic and anterior pituitary. These tumours arise from inactivating germline mutations in the MEN-1 gene. No clear correlation of MEN-1 genotype with genotype has emerged to date, and MEN-1 mutation testing in tumours is not used clinically because it have not implications for tumour staging. Multiple endocrine neoplasia type 2 is due to a germline mutation in the RET proto-oncogene. Hallmarks of MEN-2A (the commonest phenotypic variant) include medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. The most central clinical difference with MEN-1 is that the associated cancer can be prevented or cured by early thyroidectomy in mutation carriers. Individuals with neurofibomatosis type 1 present early in life with pigmentary abnormalities, skinfold freckling and iris hamartomas, as result of NF1 gene mutation. Neurofibromatosis 2 is caused by inactivating mutations of the NF2 gene, and is characterized by the development of nervous system tumours (mainly bilateral vestibular schwannomas), ocular abnormalities, and skin tumours. The molecular genetic basis of nasopharyngeal carcinomas remains unknown, but there is evidence for the linkage of these tumours to chromosome 3p. Finally, the high rate of p16 mutations in squamous cell carcinomas and the association of p16 with familial melanoma propose p16 as an ideal candidate gene predisposing to familial squamous cell carcinomas. The elucidation of the cellular processes affected by dysfunction in familial tumours of the head and neck may serve to identify potential targets for future therapeutic interventions.
Collapse
Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | | |
Collapse
|
30
|
Bhattacharya A, Mittal BR, Bhansali A, Radotra BD, Behera A. Cervical Paraganglioma Mimicking a Parathyroid Adenoma on Tc-99m Sestamibi Scintigraphy. Clin Nucl Med 2006; 31:234-6. [PMID: 16550027 DOI: 10.1097/01.rlu.0000205179.73356.9c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 32-year-old man with a clinical and biochemical profile suggestive of primary hyperparathyroidism presented with a soft tissue mass on the left side of the neck. Multiphasic planar and SPECT Tc-99m sestamibi (MIBI) scintigraphy showed focally increased tracer concentration in the mass. Subsequent histopathology and immunostaining identified the mass as a parathyroid hormone-secreting cervical paraganglioma, indicating that this tumor should be considered in the differential interpretation of MIBI concentration in the neck.
Collapse
Affiliation(s)
- Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | |
Collapse
|
31
|
Ilias I, Shulkin B, Pacak K. New functional imaging modalities for chromaffin tumors, neuroblastomas and ganglioneuromas. Trends Endocrinol Metab 2005; 16:66-72. [PMID: 15734147 DOI: 10.1016/j.tem.2005.01.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nuclear medicine modalities use radiolabeled ligands that either follow metabolic pathways or act on cellular receptors. Thus, they permit functional imaging of physiological processes and help to localize sites such as tumors that harbor pathological events. The application of positron emission tomography (PET) ligands to the specific pathways of synthesis, metabolism and inactivation of catecholamines found in chromaffin tumors, neuroblastomas and ganglioneuromas can be used to provide a more thorough localization of these types of tumor. Recent advances have been made in functional imaging to localize pheochromocytomas, paragangliomas, neuroblastomas and ganglioneuromas, including approaches based on PET with [(18)F]fluorodopamine, [(18)F]fluorohydroxyphenylalanine, [(11)C]epinephrine or [(11)C]hydroxyephedrine. Such functional imaging can complement computed tomography or magnetic resonance imaging and other scintigraphic techniques to localize these tumors before surgical or medical therapeutic approaches are considered.
Collapse
Affiliation(s)
- Ioannis Ilias
- Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
| | | | | |
Collapse
|
32
|
Abstract
Glomus tumors are a fascinating group of lesions. It is a challenge for neurosurgeons and otolaryngologists to resect them completely with minimal morbidity. Laboratory researchers have discovered extremely interesting genetic and molecular biology factors involved in the development and growth of glomus tumors. In this article the author reviews the genetics, protein mutations, angiogenesis and apoptosis associated with tumor formation, and the secretion of vasoactive substances is discussed as well. It is hoped that with further research less invasive measures may be developed to treat these tumors.
Collapse
Affiliation(s)
- Jason Heth
- Department of Neurosurgery, University of Michigan, Taubman Medical Center, Ann Arbor, Michigan 48109, USA.
| |
Collapse
|
33
|
Abstract
Paragangliomas are rare tumors that derive from neural crest tissue. Vagal paragangliomas account for only 3% of all head and neck paragangliomas. Patients with vagal paragangliomas typically present with an asymptomatic neck mass and, less frequently, with cranial neuropathies. It is estimated that only 1% to 3% of all head and neck paragangliomas secrete catecholamines. The incidence of secreting vagal paragangliomas is even smaller. The diagnosis of a secreting paraganglioma involves the use of a screening test for serum catecholamines and a 24-hour urinary test for catecholamine metabolites. The identification and staging of these tumors can be performed through the use of MRI and/or CT scans and an octreotide scintigraphy. The mainstay treatment is surgical extirpation; however, preoperative medical blockade is critical to avoid a hypertensive crisis intra-operatively. We present two illustrative cases of secreting vagal paragangliomas involving a complex diagnostic and therapeutic algorithm.
Collapse
Affiliation(s)
- Jan C Groblewski
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA
| | | | | |
Collapse
|
34
|
Bustillo A, Telischi FF. Octreotide scintigraphy in the detection of recurrent paragangliomas. Otolaryngol Head Neck Surg 2004; 130:479-82. [PMID: 15100648 DOI: 10.1016/j.otohns.2003.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conventional follow-up of surgically and radiotherapy-treated paragangliomas is usually carried out with physical examinations and either magnetic resonance imaging and/or computed tomography. Up to now, octreotide has been reserved for primary diagnosis, for which it has been shown to be a reliable imaging modality. However, the postsurgical and postradiation changes seen on conventional imaging make the diagnosis of small recurrent lesions difficult. We sought to evaluate the role of octreotide scintigraphy in the detection of recurrent paragangliomas. STUDY DESIGN We based this case series on 3 patients who were found to have recurrent paragangliomas after primary surgical resection. All patients underwent octreotide scintigraphy during routine follow-up. RESULTS Three patients were found to have recurrent paragangliomas using octreotide scintigraphy. In one of the patients, conventional imaging (magnetic resonance imaging, computed tomography) failed to detect the recurrence. CONCLUSION The octreotide study was able to detect the small recurrences because octreotide binds directly to receptors on the tumor and is not affected by postsurgical or postradiotherapy changes. The intrinsic resolution of most commercially available gamma cameras is about 1 cm, making it quite sensitive to detect small tumors. Although this patient did not have synchronous lesions, octreotide scintigraphy can also aide in the detection of such lesions.
Collapse
Affiliation(s)
- Andres Bustillo
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida 33136, USA
| | | |
Collapse
|
35
|
Bustillo A, Telischi F, Weed D, Civantos F, Angeli S, Serafini A, Whiteman M. Octreotide scintigraphy in the head and neck. Laryngoscope 2004; 114:434-40. [PMID: 15091215 DOI: 10.1097/00005537-200403000-00010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS Octreotide is a somatostatin analogue that, when coupled to a radioisotope, produces a scintigraphic image of neuroendocrine tumors (NET) expressing somatostatin type 2 receptors (SSR 2). Octreotide scintigraphy (OS) may be useful in confirming the preoperative diagnosis of certain head and neck NET. Paragangliomas (PG), like many NET, have been found to have a high density of SSR 2 on the cell surfaces. Other NET of the head and neck include merkel cell carcinomas (MCC), medullary thyroid carcinomas (MTC), and esthesioneuroblastomas. STUDY DESIGN A retrospective study that compared the results of OS with the histopathologic diagnosis in 74 patients with head and neck NET. RESULTS Of the 60 patients undergoing evaluation for suspected paraganglioma, OS was correctly positive in 36 of the 37 patients with PG. OS was correctly negative in 19 of the 23 patients that did not exhibit PG. For PG, this yielded a sensitivity of 97% and a specificity of 82%. There were 14 patients in the nonparaganglioma group. OS detected or diagnosed all metastases in three patients with MTC, locoregional recurrences in two patients with esthesioneuroblastoma, an extrapituitary adenoma in one patient, and metastasis in two patients with MCC. It failed to detect a paraspinal metastasis in the third patient with MCC. CONCLUSION On the basis of this series of patients, OS appears to be a reliable test to detect PG and may be helpful in detecting primary and metastatic disease for NET.
Collapse
Affiliation(s)
- A Bustillo
- Departments of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, Miami, Florida 33101, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
|
37
|
Abstract
BACKGROUND Pediatric paraganglioma is rare and extraadrenal paraganglioma has not been characterized in children. METHODS The authors reviewed the medical records and pathology samples of children with extraadrenal paraganglioma treated at our institution between December 1978 and September 2000. Clinical presentation, treatment, and outcome were evaluated. RESULTS Eight patients (median age, 11.4 years) were identified, 4 were boys and none had a family history of paraganglioma or associated syndromes. Primary tumors arose in the retroperitoneum (n = 3), carotid body (n = 2), jugulotympanic ganglion (n = 1), cervical-paraspinal region (n = 1), and lung (n = 1). Extraadrenal paraganglioma had not been suspected at presentation in any patient. Of 5 patients who underwent gross total resection at the time of diagnosis, 4 remain disease free, 1 had microscopic residual tumor and died of disease. Three patients had initially unresectable disease, 2 are disease free after neoadjuvant therapy and delayed surgery, and 1 has persistent disease after tumor embolization and radiotherapy. CONCLUSIONS Pediatric extraadrenal paraganglioma occurs most commonly in the retroperitoneum and head and neck, and the diagnosis usually is not suspected at the time of presentation. Surgery is the mainstay of treatment, and outcome is good after gross total resection. Neoadjuvant therapy can facilitate complete resection of initially unresectable tumors.
Collapse
Affiliation(s)
- Tanya M Tekautz
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
| | | | | | | |
Collapse
|
38
|
Abstract
Carney's triad represents the association of gastric gastrointestinal stromal tumor, pulmonary chondroma, and extraadrenal paraganglioma. Only 79 cases of this rare condition have been described. Here, the authors describe the unusual case of a 14-year-old boy who presented with a complete Carney's triad. This is only the second reported case in the world literature of a patient manifesting a complete Carney's triad at presentation. The management of each tumor is discussed.
Collapse
Affiliation(s)
- Paul W Wales
- Division of Paediatric General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | |
Collapse
|
39
|
McCaffrey TV, Myssiorek D, Marrinan M. Head and neck paragangliomas: physiology and biochemistry. Otolaryngol Clin North Am 2001; 34:837-44, v. [PMID: 11557442 DOI: 10.1016/s0030-6665(05)70350-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Paragangliomas of the head and neck are derivatives of neural crest cells, comprising part of the diffuse neuroendocrine system. Indeed, paragangliomas encompass a unique subset of tumors of the head and neck. Their biochemistry and physiology are similar to other neuroendocrine tumors unlike tumors based on location. This article discusses their distinct biologic attributes.
Collapse
Affiliation(s)
- T V McCaffrey
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | | | | |
Collapse
|
40
|
Lustrin ES, Palestro C, Vaheesan K. Radiographic evaluation and assessment of paragangliomas. Otolaryngol Clin North Am 2001; 34:881-906, vi. [PMID: 11557445 DOI: 10.1016/s0030-6665(05)70353-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiographic imaging plays an important role in the diagnosis and treatment of paragangliomas. Diagnosis and treatment should be performed as a team effort, with all the involved disciplines working together to provide the best possible individualized work-up and treatment plan for the patient.
Collapse
Affiliation(s)
- E S Lustrin
- Department of Radiology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA
| | | | | |
Collapse
|
41
|
Paragangliomas of the head and neck: implications of molecular genetics in clinical medicine. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200010000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Petropoulos AE, Luetje CM, Camarata PJ, Whittaker CK, Lee G, Baysal BE. Genetic analysis in the diagnosis of familial paragangliomas. Laryngoscope 2000; 110:1225-9. [PMID: 10892701 DOI: 10.1097/00005537-200007000-00030] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the management of two related patients with multicentric glomus jugulare tumors, given the incidence of 1:30,000 with approximately 20% familial cases, our objective was to review the genetic characteristics and inheritance patterns of these tumors and to determine what molecular genetic screening possibilities exist for the phenotypically normal family members. In addition, our aim was to review the incidence of various multicentric paraganglioma (PGL) tumor location combinations. METHODS Molecular genetic linkage analysis testing was performed on the 2 patients and 14 other unaffected family members. We report the results of this screening and review the literature on the incidence and genetics of paragangliomas. RESULTS The inheritance pattern in the literature demonstrates autosomal dominant transmission with maternal imprinting (inactivation). The proclivity for multicentric origin increases to 26% in familial cases, as reflected in our patients. In addition to the two patients, four unaffected family members demonstrated the presence of the disease haplotype at chromosome band 11q23, which indicates a very high likelihood of developing a paraganglioma, given the highly penetrant nature of the disease. CONCLUSIONS It is clear that the familial PGL gene locus is situated at chromosome 11q23. The gene itself and its exact degree of penetrance, however, still await identification. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis as a screening tool in families of affected patients should play a front-line diagnostic role, leading to more timely and cost-effective patient management.
Collapse
Affiliation(s)
- A E Petropoulos
- Otologic Center and Midwest Ear Institute, Kansas City, Missouri 64111, USA
| | | | | | | | | | | |
Collapse
|