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Mier Y Teran-Ellis S, Bobadilla-Rosado LO, Anaya-Ayala JE, Estrada-Rodriguez HA, Dominguez-Vega RX, Gonzalez-Duarte A, Hinojosa CA. Carotid baroreceptor dysfunction after carotid body tumour resections. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108550. [PMID: 39047327 DOI: 10.1016/j.ejso.2024.108550] [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: 03/08/2024] [Revised: 06/01/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Carotid body tumours (CBTs) and baroreceptor failure (BRF) are two distinct but interrelated conditions, affecting the carotid body and its regulatory mechanisms. We aim to describe and quantify BRF after unilateral and bilateral CBT resections. METHODS Prospective cohort study. We included all patients with unilateral or bilateral CBT undergoing resection from April 2021 to January 2023. Demographics and CBTs characteristics were analysed; baroreceptor sensitivity assessment was conducted using the Composite Autonomic Severity Score (CASS). Statistical analyses were performed using R. Significance level was set at a 2-tailed α = 0.05. RESULTS A total of 30 patients with CBT underwent surgical resection, twenty-three were included in the study (18 unilateral and 5 bilateral CBTs). All 23 (100 %) were females, median age of 60 years. Regarding patients with unilateral CBT; preoperatively, 13 had BRF, the most common dysfunction subtype was mixed. Postoperatively, the most common dysfunction subtype was sympathetic failure. With regards to bilateral CBTs; 2 patients did not have autonomic dysfunction preoperatively. After bilateral surgical resection one patient remained without autonomic dysfunction; however, all other patients persisted with BRF. CONCLUSION BRF was present in 13 patients with unilateral CBT and 3 patients with bilateral tumours preoperatively; most will remain with BRF and will only change the characteristics postoperatively. No associations were found between type, severity of BRF and Shamblin classification or laterality. It is paramount that research in this area continues as many features are yet unknown regarding CBT pathogenesis, hence, BRF may be present yet not affect significantly quality of life.
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Affiliation(s)
- Santiago Mier Y Teran-Ellis
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico; Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de La Salud, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico; Vascular & Endovascular Surgery Program, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Luis O Bobadilla-Rosado
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico
| | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico; Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de La Salud, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Humberto A Estrada-Rodriguez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Rosa X Dominguez-Vega
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Alejandra Gonzalez-Duarte
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Department of Neurology at New York University Grossman School of Medicine, New York, NY, USA
| | - Carlos A Hinojosa
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico; Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de La Salud, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
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周 政, 吴 牡, 李 维, 艾 金, 张 晓, 陈 玉, 宋 业, 王 芳, 沈 阳, 谭 国. [Baroreceptor failure syndrome after head and neck tumor surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1052-1056. [PMID: 34886615 PMCID: PMC10128367 DOI: 10.13201/j.issn.2096-7993.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 04/30/2023]
Abstract
With the continuous updating of head and neck surgery concepts and techniques, more and more head and neck surgeries are developing in the direction of refinement.however, the more complete the surgery, the greater the possibility of subsequent nerve exposure and injury. Even a slight perturbation of the nerve may cause serious complications, such as pressure receptor failure.It is necessary to review the mechanisms and the characteristics of baroreceptor failure syndrome after head and neck tumor surgery.
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Affiliation(s)
- 政 周
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 牡丽 吴
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 维 李
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 金刚 艾
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 晓伟 张
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 玉 陈
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 业勋 宋
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 芳 王
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 阳 沈
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 国林 谭
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
- 谭国林,
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Aru RG, Aouad RK, Fraser JF, Romesberg AM, Hatton KW, Tyagi SC. Operative management of symptomatic, metachronous carotid body tumors involving the skull base and its neurological sequelae. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:378-381. [PMID: 34278062 PMCID: PMC8261542 DOI: 10.1016/j.jvscit.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
A 44-year-old morbidly obese woman with a history of right carotid body tumor (CBT) resection presented with a symptomatic, nonfunctional, left Shamblin-III CBT. Abutment of the skull base precluded distal internal carotid artery control for arterial reconstruction, favoring parent vessel sacrifice after an asymptomatic provocative test. She underwent CBT resection with anticipated sacrifice of cranial nerves X and XII and the common carotid artery and its branches, developing baroreceptor failure syndrome and sequelae of cranial nerve sacrifice. When facing a symptomatic, metachronous CBT abutting the skull base, upfront operative intervention with adjuvant radiation for residual tumor optimizes curative resection.
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Affiliation(s)
- Roberto G Aru
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, Ky
| | - Rony K Aouad
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Ky
| | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, Ky
| | | | - Kevin W Hatton
- Division of Critical Care Medicine, Department of Anesthesiology, University of Kentucky, Lexington, Ky
| | - Sam C Tyagi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, Ky
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4
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Shah-Becker S, Pennock M, Sinoway L, Goldenberg D, Goyal N. Baroreceptor reflex failure: Review of the literature and the potential impact on patients with head and neck cancer. Head Neck 2017; 39:2135-2141. [PMID: 28675547 DOI: 10.1002/hed.24857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/21/2017] [Accepted: 05/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Baroreceptor dysfunction and reflex failure may occur after surgery affecting the carotid artery. The implications for patients undergoing treatment for head and neck cancer are not well described. METHODS A literature search of PubMed was performed between March 2016 and May 2016. Search terms used individually and in combination included: "baroreflex failure," "carotid sinus sensitivity," "carotid endarterectomy," "carotid body tumor," and "head and neck cancer." Bibliographies of included articles were also reviewed for additional pertinent articles. RESULTS There is evidence of baroreceptor failure in certain patients after interventions associated with the carotid artery, including carotid endarterectomy and carotid body tumor excision. Few studies have been performed investigating the potential effect of head and neck surgery treatment, including surgery and/or radiation, on baroreflex function. CONCLUSION Head and neck cancer treatment has the potential to cause baroreflex failure, and this is likely an underrecognized and underdiagnosed condition.
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Affiliation(s)
- Shivani Shah-Becker
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Michael Pennock
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Lawrence Sinoway
- Penn State Hershey Heart and Vascular Institute, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - David Goldenberg
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Neerav Goyal
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Ghali MG, Srinivasan VM, Hanna E, DeMonte F. Overt and Subclinical Baroreflex Dysfunction After Bilateral Carotid Body Tumor Resection: Pathophysiology, Diagnosis, and Implications for Management. World Neurosurg 2017; 101:559-567. [DOI: 10.1016/j.wneu.2017.02.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022]
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6
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Lv H, Chen X, Zhou S, Cui S, Bai Y, Wang Z. Imaging findings of malignant bilateral carotid body tumors: A case report and review of the literature. Oncol Lett 2016; 11:2457-2462. [PMID: 27073498 DOI: 10.3892/ol.2016.4227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 12/10/2015] [Indexed: 11/05/2022] Open
Abstract
Carotid body tumors (CBTs) are a rare type of extra-adrenal paraganglioma, which originate from the carotid body. A 29-year-old woman was admitted to the Department of Head and Neck Surgery, Beijing Tongren Hospital (Capital Medical University, Beijing, China) with hoarseness of the throat, which had progressively worsened over seven months. The patient had a family history of CBTs. Computed tomography and ultrasound imaging revealed multiple well-enhanced masses located at the bilateral carotid bifurcation and in the left parapharyngeal space. Surgery and pathological examination confirmed that the patient had developed regional lymph node metastasis. Significantly enhanced multiple pulmonary and hepatic lesions indicated that the patient had also developed distal metastasis. A genetic analysis performed on the family members of the patient revealed that the family carried a mutated succinate dehydrogenase D gene. In the present study, a systemic review of the literature indicated that extra vigilance is required in familial forms of CBT, in order to increase the standard of treatment for CBT patients.
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Affiliation(s)
- Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiaohong Chen
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China; Department of Otolaryngology, Head and Neck Surgery, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Shuai Zhou
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Suping Cui
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Yunlong Bai
- Department of Otolaryngology, Head and Neck Surgery, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
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7
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Zeng G, Zhao J, Ma Y, Huang B, Yang Y, Feng H. A Comparison Between the Treatments of Functional and Nonfunctional Carotid Body Tumors. Ann Vasc Surg 2012; 26:506-10. [DOI: 10.1016/j.avsg.2011.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/25/2011] [Accepted: 11/04/2011] [Indexed: 11/28/2022]
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8
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Konishi M, Piazza P, Shin SH, Sivalingam S, Sanna M. The use of internal carotid artery stenting in management of bilateral carotid body tumors. Eur Arch Otorhinolaryngol 2011; 268:1535-9. [DOI: 10.1007/s00405-011-1731-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 07/20/2011] [Indexed: 11/21/2022]
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9
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Gur I, Katz S. Baroreceptor Failure Syndrome After Bilateral Carotid Body Tumor Surgery. Ann Vasc Surg 2010; 24:1138.e1-3. [DOI: 10.1016/j.avsg.2010.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 04/02/2010] [Accepted: 05/11/2010] [Indexed: 11/17/2022]
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10
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Guss ZD, Batra S, Li G, Chang SD, Parsa AT, Rigamonti D, Kleinberg L, Lim M. Radiosurgery for glomus jugulare: history and recent progress. Neurosurg Focus 2009; 27:E5. [DOI: 10.3171/2009.9.focus09195] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this article the authors review the literature for recent studies of radiosurgical treatment for glomus jugulare. These studies demonstrate that radiosurgery results in similar glomus jugulare tumor control and a superior morbidity profile compared with surgical treatment. In addition, patients treated with radiosurgery usually remain stable clinically or improve. Given the indolent nature of these tumors, however, more follow-up is required to ensure that the immediate benefits are lasting. These preliminary reports demonstrate that the use of radiosurgery as a primary treatment for glomus jugulare should be extended to encompass more of the patients who are currently assigned to microsurgical treatment.
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Affiliation(s)
| | | | - Gordon Li
- 2Department of Neurosurgery, Stanford University Medical Center, Stanford; and
| | - Steven D. Chang
- 2Department of Neurosurgery, Stanford University Medical Center, Stanford; and
| | - Andrew T. Parsa
- 3Department of Neurological Surgery, University of California, San Francisco, California
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Atefi S, Nikeghbalian S, Yarmohammadi H, Assadi-Sabet A. Surgical management of carotid body tumours: a 24-year surgical experience. ANZ J Surg 2006; 76:214-7. [PMID: 16681534 DOI: 10.1111/j.1445-2197.2006.03698.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid body tumours (CBT) are rare tumours, best treated by complete surgical resection. However, there is no uniform agreement on the method of resection. The aim of this study was to review our 24 years' experience of meticulous subadventitial excision of CBT. METHODS A retrospective study, from March 1980 to September 2004 of patients with CBT was undertaken, detailing presentation, diagnosis and treatment and postoperative complications. RESULTS Twenty-five patients (six men and 19 women) with an age range of 23-72 years had been operated on, and all were treated by surgical excision. All patients had neck mass. No patient had a positive family history. Angiography was the main method of diagnosis. All of the patients had unilateral tumours. There was no postoperative permanent neurological deficit. Temporary neurological problems developed in only four patients. External carotid artery was ligated in three patients to facilitate excision of the tumour. Surgical care limited blood loss to an average of 480 mL. CONCLUSIONS Subadventitial excision, carried out meticulously, allowed complete resection to be achieved in all of the patients with minimal morbidity and no surgical mortalities. This method is therefore recommended. Facilities for shunting and arterial repair should always be available.
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Affiliation(s)
- Sohrab Atefi
- Department of Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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van Houtum WH, Corssmit EPM, Douwes Dekker PB, Jansen JC, van der Mey AGL, Bröcker-Vriends AHJT, Taschner PEM, Losekoot M, Frölich M, Stokkel MPM, Cornelisse CJ, Romijn JA. Increased prevalence of catecholamine excess and phaeochromocytomas in a well-defined Dutch population with SDHD-linked head and neck paragangliomas. Eur J Endocrinol 2005; 152:87-94. [PMID: 15762191 DOI: 10.1530/eje.1.01833] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to identify the prevalence of catecholamine excess and phaeochromocytomas in a well-defined population of people with hereditary head and neck paragangliomas. METHODS We studied in a prospective follow-up protocol all consecutive patients referred to the Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands with documented head and neck paragangliomas and either a positive family history for paragangliomas or a proven SDHD gene mutation. Initial analysis included medical history, physical examination and the measurement of excretion of catecholamines in two 24-h urine collections. In the case of documented catecholamine excess iodinated meta-iodobenzylguanidine (123I-MIBG) scintigraphy and magnetic resonance imaging were done. RESULTS Between 1988 and 2003, 40 consecutive patients (20 male and 20 female) with documented head and neck paragangliomas were screened. Biochemical screening revealed urinary catecholamine excess in 15 patients (37.5%). In nine of these 15 patients a lesion was found by 123I-MIBG scintigraphy. Exact localization by magnetic resonance imaging revealed phaeochromocytomas in seven of the 15 patients. One of the nine patients had an extra-adrenal paraganglioma. Histopathological examination in a subset of tumors displayed loss of heterozygosity of the wild-type SDHD allele in all cases. CONCLUSIONS The prevalence of catecholamine excess (37.5%) and phaeochromocytomas (20.0%) is high in patients with familial head and neck paragangliomas. Therefore, patients with hereditary head and neck paragangliomas require lifelong follow up by biochemical testing for catecholamine excess.
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Affiliation(s)
- W H van Houtum
- Leiden University Medical Center, Departments of Endocrinology and Metabolic Diseases, Leiden, The Netherlands
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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.
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Affiliation(s)
- A E Petropoulos
- Otologic Center and Midwest Ear Institute, Kansas City, Missouri 64111, USA
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14
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Carney JA. Gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal paraganglioma (Carney Triad): natural history, adrenocortical component, and possible familial occurrence. Mayo Clin Proc 1999; 74:543-52. [PMID: 10377927 DOI: 10.4065/74.6.543] [Citation(s) in RCA: 344] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the natural history of the triad of gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal paraganglioma, a rare syndrome of unknown cause primarily affecting young women. METHODS Mayo Clinic records, the world literature, and the author's files were searched for patients with all or 2 of the 3 tumors. RESULTS Seventy-nine patients, 67 women and 12 men, were identified, 17 (22%) with the 3 tumors and 62 (78%) with 2 tumors. Forty-two (53%) had gastric and pulmonary tumors, the most common combination. The longest interval between detection of the first and second components was 26 years (mean, 8.4 years; median, 6 years). Follow-up ranged from 1 year to 49 years (mean, 20.6 years; median, 20 years). Sixty-four patients (81%) were alive, 19 (24%) apparently free of disease and 45 (57%) with residual or metastatic tumors. Thirty-two patients (41%) had had 1 or more local recurrences of the gastric sarcoma; the longest interval to first recurrence was 36 years. Twenty-one survivors (27%) had hepatic metastatic gastric sarcoma with follow-up of 1 year to 25 years (mean, 9.3 years; median, 7 years). Fifteen patients (19%) were dead, 10 (13%) of whom died of the disorder. Ten patients (13%) had nonfunctioning adrenocortical tumors. Two patients each had a sibling with 1 component of the triad. CONCLUSIONS The triad is a chronic, persistent, and indolent disease. Benign adrenocortical tumors are a component of the condition. The disorder may be familial.
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Affiliation(s)
- J A Carney
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN 55905, USA
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15
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Leonetti JP, Donzelli JJ, Littooy FN, Farrell BP. Perioperative strategies in the management of carotid body tumors. Otolaryngol Head Neck Surg 1997; 117:111-5. [PMID: 9230333 DOI: 10.1016/s0194-59989770216-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the availability of noninvasive neuroradiographic techniques for the evaluation of head and neck neoplasms, paragangliomas of the carotid body often achieve substantial size before definitive diagnosis. Surgical “exploration” for the attempted resection of these lesions often results in significant blood loss, inadvertent cranial nerve injury, and procedure abandonment with partial tumor removal. Sixteen carotid body tumors were surgically resected at our institution between July 1988 and January 1995. Four of these patients had undergone cytologic examination by fine-needle aspiration (FNA) and another 6 patients underwent failed attempted resection of their lesions as the result of intraoperative hemorrhage. Of the remaining 6 patients referred for the first time evaluation of a “neck mass,” the diagnosis was made by patient history, physical examination, magnetic resonance imaging, or magnetic resonance angiography. Complete tumor removal was accomplished in all 16 patients using a variety of lateral transcervical and skull base approaches. This article focuses on the clinicoradiographic diagnosis of carotid body tumors that do not need preoperative histologic confirmation. Specific intraoperative techniques for tumor removal, carotid artery management, and cranial nerve preservation are demonstrated through case presentations. Perioperative morbidity and overall results are detailed for this series of patients.
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Affiliation(s)
- J P Leonetti
- Department of Otolaryngology-Head and Neck Surgery, Loyola University of Chicago, Maywood, Illinois 60153, USA
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16
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Abstract
A case of left carotid body tumor is presented. A 47-year-old female patient consulted our otorhinolaryngological clinic with a neck swelling that had persisted for 5 months. On physical examination, a movable and pulsating hard mass measuring 2 x 2.5 cm in size was found on the left side of her neck, near the angle of the mandible. Computed tomography, magnetic resonance image and angiography all demonstrated a well-circumscribed tumor mass showing high vascularity and located at the bifurcation of the left carotid artery. The tumor involved the left carotid artery, but the patency of the artery was preserved. The patient showed satisfactory temporary balloon occlusion test results without neurological complications. Since the tumor was strongly adherent to the carotid arterial wall, the tumor was resected together with the carotid artery. Histologically, the tumor was composed of organoid clusters of round cells with eosinophilic granular cytoplasm. Involvement of tumor cells was seen to the adventitia of the carotid artery, but only slight cellular atypia was seen. Ultrastructurally, two types of cells were observed in the central and marginal portion of the tumor; these were round chief cells with few cytoplasmic neurosecretory granules and spindle-shaped sustentacular cells. Immunohistochemically, the chief cells and sustentacular cells showed positive reaction for neuron-specific enolase and S-100, respectively. The ultrastructural findings suggested the benign nature of the tumor.
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Affiliation(s)
- S Kojya
- Department of Otorhinolaryngology, School of Medicine, University of the Ryukyus, Okinawa, Japan
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17
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Netterville JL, Reilly KM, Robertson D, Reiber ME, Armstrong WB, Childs P. Carotid body tumors: a review of 30 patients with 46 tumors. Laryngoscope 1995; 105:115-26. [PMID: 8544589 DOI: 10.1288/00005537-199502000-00002] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Minimal morbidity occurs with resection of most carotid body tumors (CBT). With larger tumors significant injury to the cranial nerves has been reported. In order to assess the operative sequelae rate, 30 patients with CBT were reviewed. Sixteen patients either presented with bilateral carotid body tumors or had previously undergone a resection of the contralateral carotid body tumors, for a total carotid body tumor count of 46. Sixteen patients demonstrated a familial pattern while 14 were nonfamilial. Within the familial group, 14 of 16 presented with multiple paragangliomas as compared to 6 of 14 in the nonfamilial group. Tumor size ranged from 0.8 to 12 cm. Vascular replacement occurred in 2 of 20 patients with tumors < 5.0 cm, compared with 5 of 9 with tumors > 5.0 cm. Four patients lost cranial nerves with the resection: superior laryngeal nerve (SLN), 4; cranial nerve X, 1; cranial nerve XII, 1. Ten patients developed baroreceptor failure secondary to bilateral loss of carotid sinus function. First-bite pain occurred in 10 of 25 operative patients. Cranial nerve loss can be minimal with resection of carotid body tumors, however, baroreceptor failure and first-bite pain are postoperative sequelae that are often disregarded in the postoperative period.
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Affiliation(s)
- J L Netterville
- Department of Otolaryngology, Vanderbilt Medical Center, Nashville, Tenn 37232, USA
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Ridge BA, Brewster DC, Darling RC, Cambria RP, LaMuraglia GM, Abbott WM. Familial carotid body tumors: incidence and implications. Ann Vasc Surg 1993; 7:190-4. [PMID: 8518138 DOI: 10.1007/bf02001015] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Carotid body tumors may occur sporadically (90%) or in a familial pattern (10%). One third of the patients with familial disease have bilateral tumors. We report the case of a patient with bilateral carotid body tumors and a strong family history of such tumors. Details of his evaluation and treatment are reviewed. Relatives of patients with carotid body tumors should be examined carefully, and any suspicious neck mass should be appropriately investigated.
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Affiliation(s)
- B A Ridge
- Surgical Service, Massachusetts General Hospital, Boston
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van der Mey AG, Maaswinkel-Mooy PD, Cornelisse CJ, Schmidt PH, van de Kamp JJ. Genomic imprinting in hereditary glomus tumours: evidence for new genetic theory. Lancet 1989; 2:1291-4. [PMID: 2574254 DOI: 10.1016/s0140-6736(89)91908-9] [Citation(s) in RCA: 221] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A study based on fifteen pedigrees showed that familial glomus tumours are inherited almost exclusively via the paternal line, a finding inconsistent with autosomal dominant transmission. The results can be explained in terms of the genomic imprinting hypothesis--the maternally derived gene is inactivated during female oogenesis and can be reactivated only during spermatogenesis. Genomic imprinting may have considerable implications for genetic counselling with respect to glomus tumours and also for the understanding of other hereditary diseases.
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Affiliation(s)
- A G van der Mey
- Department of Otolaryngology, University Hospital, Leiden, The Netherlands
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Robinson AC, Lukaszewicz CM. View from within--radiology in focus. Bilateral carotid body tumours. J Laryngol Otol 1989; 103:543-4. [PMID: 2754329 DOI: 10.1017/s0022215100156841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- A C Robinson
- Department of Otolaryngology, Royal Surrey County Hospital, Guildford
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Wood GA, Pogrel MA, Hardman FG. Cervical paragangliomas: a report of four cases. Br J Oral Maxillofac Surg 1986; 24:169-77. [PMID: 2941063 DOI: 10.1016/0266-4356(86)90071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Four cases of cervical paragangliomas are reported. Two cases were of presumed vagal origin and two were carotid body tumours. In three of the cases the diagnosis was not made prior to surgery. The diagnosis, pathology and management of the cases are discussed.
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Kabnick EM, Serchuk L, Adler L. Metastatic chemodectoma. J Natl Med Assoc 1985; 77:750, 755-6. [PMID: 4057278 PMCID: PMC2571168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The authors report a case of primary chemodectoma with metastasis to the lungs. To date only 11 such cases have been reported in the literature.
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van Baars F, Cremers C, van den Broek P, Geerts S, Veldman J. Genetic aspects of nonchromaffin paraganglioma. Hum Genet 1982; 60:305-9. [PMID: 6286462 DOI: 10.1007/bf00569208] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Paragangliomas may arise in any area of the body where nonchromaffin paraganglia are situated. These include the glomus jugulare, the carotid body, and the retroperitoneum. Malignant behavior of these paragangliomas has been a controversial subject with most authors, who consider them to be benign tumors. Some authors have diagnosed locally recurrent and infiltrative tumors as malignant, whereas most require the demonstration of metastatic potential as the only criterion for malignancy. Two cases of metastasizing carotid body tumors are reported with a review of the literature on this unusual neoplasm.
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Abstract
We report on the cases of two sisters with carotid body tumor (CBT) and present a literature review that assembles epidemiologic information on 88 familial and 835 nonfamilial CBT patients. The sex ratio (males/females) of 1.0 for familial CBT (0.7 for nonfamilial) and CBT reports with complete sibship information suggest autosomal dominant genetic transmission. As in other familial cancers, bilateral disease is significantly more frequent in familial (31.8% of cases) than in nonfamilial CBT (4.4%). However, there is no difference in age at diagnosis between familial and nonfamilial CBR. Thus, this adult-onset familial cancer does not completely fit the Knudson "two-step mutation" model of carcinogenesis. We also found that 6% of reported CBT patients developed second primary tumors, mostly other paragangliomas. This feature suggests that CBT may be part of a larger neurocristopathy syndrome of multiple tumors of cells of neural crest origin.
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Peters JL, Ward MW, Fisher C. Diagnosis of a carotid body chemodectoma with dynamic radionuclide perfusion scanning. Am J Surg 1979; 137:661-4. [PMID: 222160 DOI: 10.1016/0002-9610(79)90043-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The first case of a carotid body chemodectoma that was diagnosed using dynamic radionuclide perfusion angiography and subsequently excised is presented. The value of this technic in the investigation of pulsatile tumors is emphasized.
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Abstract
A case of a paraganglioma located over the thyroid cartilage in the midline is reported. The tumor had all the appearances of a carotid body tumor, but its odd location could not be explained on the basis of previously known areas where paraganglionic tissues have been found. Since a paraganglioma has also hitherto been described within the thyroid gland, clinicians and pathologists alike are cautioned that unusually located paragangliomas may be expected in the future.
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