1
|
Takata Y, Anzai T, Sonoda K, Okada H, Ishimizu E, Nakamura M, Hara S, Nakayama T, Matsumoto F. Combined underwater endoscopic and microscopic surgery for tympanic paraganglioma: A case report. Sci Prog 2024; 107:368504241263524. [PMID: 39043202 PMCID: PMC11271120 DOI: 10.1177/00368504241263524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The resection of middle ear paragangliomas can be challenging given their vascular nature and the small volume of the tympanic cavity, particularly when the tumor in the hypotympanum is close or attached to the internal carotid artery (ICA). We performed combined underwater endoscopic and microscopic surgery for a Class B1 middle ear paraganglioma according to the modified Fisch classification. The suspicious bone in the hypotympanum and around the petrous ICA was drilled with underwater endoscopy. The feeding arteries, the caroticotympanic and inferior tympanic arteries, were suctioned and cauterized under microscopy. To the best of our knowledge, no case of middle ear paraganglioma treated with underwater endoscopy has been reported. Underwater endoscopy, providing a clear operative field with blood and bone dust irrigation, is a good indication for middle ear paragangliomas. In contrast, microscopic preparation for unexpected bleeding is important, particularly when the tumor closely extends to vital structures, such as the ICA or the jugular bulb.
Collapse
Affiliation(s)
- Yusuke Takata
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Anzai
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenji Sonoda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroko Okada
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Erina Ishimizu
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masahiro Nakamura
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Hara
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takumi Nakayama
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Fancello G, Fancello V, Ehsani D, Porpiglia V, Piras G, Caruso A, Sanna M. Tumor progression in tympanojugular paragangliomas: the role of radiotherapy and wait and scan. Eur Arch Otorhinolaryngol 2024; 281:2779-2789. [PMID: 38184495 DOI: 10.1007/s00405-023-08413-y] [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: 09/28/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Tympanojugular paragangliomas (TJ PGLs) are rare tumors characterized by bone infiltration and erosion and a close relationship with critical structures, such as cranial nerves and internal carotid artery. For these reasons, their management represents a tough challenge. Since the fifties, radio-therapy (RT) has been proposed as an alternative treatment aimed at avoiding tumor progression. However, the indolent nature of the tumor, characterized by slow growth, is a crucial factor that needs to be considered before offering radiation. METHODS This study aims to examine tumor progression in RT patients through a systematic review of the literature and in TJ PGL patients who underwent solely wait and scan at our department. RESULTS The rate of tumor progression in the RT group was 8.9%, while in the wait and scan cohort was 12.9%. This data suggests the innate slow growth of PGLs. However, it is not possible to draw certain conclusions because of the wide heterogeneity of the studies. CONCLUSION When complete surgical excision of TJ PGLs is not feasible, appropriate counseling and patient selection, including comprehensive tumor classification, should be performed before proposing RT to control tumor progression, since wait and scan may represent a reasonable option in selected cases.
Collapse
Affiliation(s)
- Giuseppe Fancello
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy
- Department of Otorhinolaryngology, Careggi University Hospital, 50134, Florence, Italy
| | - Virginia Fancello
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy.
- Ear Nose and Throat and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124, Ferrara, Italy.
- ENT Department, Azienda Ospedaliero Universitaria - Sassari, 07100, Sassari, Italy.
| | - Diana Ehsani
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy
- Ear Nose and Throat and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Vincenzo Porpiglia
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy
- Audiology Unit, Department of Specialistic Surgical Sciences, IRCCS Cà Granda Foundation, Policlinic of Milan, Milan, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy
| | - Antonio Caruso
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Otologic Group, 29121, Piacenza, Italy
| |
Collapse
|
3
|
Salem MA, Ghoneim M, Ahmed SS, Elsobki A, Elzhzahy AA, Hemdan A. Endoscopic transcanal coblation excision of glomus tympanicum: a novel technique. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08660-7. [PMID: 38689036 DOI: 10.1007/s00405-024-08660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the feasibility of coblation in excision of glomus tympanicum tumors. PATIENTS AND METHODS A retrospective study carried out over 28 patients with types I and II glomus tympanicum tumors according to GLASSCOCK-JACKSON classification. Preoperative radiological and endocrinal evaluation were performed. All patients underwent endoscopic transcanal excision of their glomus tympanicum tumors using coblation. RESULTS None of the patients developed recurrence during the 1-year follow up period proved radiologically. None of the patients developed facial palsy postoperatively. Differences between preoperative and postoperative dizziness and taste disturbance were statistically non-significant. Tinnitus disappeared completely in 22 patients postoperatively. A statistically significant reduction in Tinnitus Handicap Inventory (THI) after surgery was found. Statistically significant reductions in postoperative air conduction (AC) threshold and air bone gap (ABG) were recorded while bone conduction (BC) threshold showed statistically non-significant change. CONCLUSION Coblation is an effective and safe tool in excision of glomus tympanicum tumors. Further studies comparing coblation with laser and piezosurgery are strongly recommended.
Collapse
Affiliation(s)
- Mohammed Abdelbadie Salem
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Mahitab Ghoneim
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Sally Sameh Ahmed
- Department of Endocrinology, Diabetes and Metabolism, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Elsobki
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Abdoo Elzhzahy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Hemdan
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt.
| |
Collapse
|
4
|
Vimawala SN, Graboyes AZ, Bennett B, Bonanni M, Abbasi A, Oliphant T, Alonso-Basanta M, Rassekh C, Cohen D, Brant JA, Huan Y. Head and Neck Paragangliomas: Overview of Institutional Experience. Cancers (Basel) 2024; 16:1523. [PMID: 38672605 PMCID: PMC11049203 DOI: 10.3390/cancers16081523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Head and neck paragangliomas (HNPGLs) are rare and have high rates of genetic mutations. We conducted a retrospective review of 187 patients with 296 PGLs diagnosed between 1974 and 2023. The mean age of diagnosis was 48.8 years (range 10 to 82) with 69.0% female and 26.5% patients with multiple PGLs. Among 119 patients undergoing genetic testing, 70 (58.8%) patients had mutations, with SDHB (30) and SDHD (26) being the most common. The rates of metastasis and recurrence were higher among patients with SDHB mutations or SDHD mutations associated with multiple PGLs. Metabolic evaluation showed elevated plasma dopamine levels were the most common derangements in HNPGL. MRI and CT were the most common anatomic imaging modalities and DOTATATE was the most common functional scan used in this cohort. Most patients (81.5%) received surgery as the primary definitive treatment, while 22.5% patients received radiation treatment, mostly as an adjuvant therapy or for surgically challenging or inoperable cases. Systemic treatment was rarely used in our cohort. Our single-center experience highlights the need for referral for genetic testing and metabolic evaluation and for a team-based approach to improve the clinical outcomes of patients with HNPGLs.
Collapse
Affiliation(s)
- Swar N. Vimawala
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, NJ 08103, USA;
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.Z.G.); (T.O.); (C.R.)
| | - Alex Z. Graboyes
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.Z.G.); (T.O.); (C.R.)
| | - Bonita Bennett
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.B.); (M.B.); (D.C.)
| | - Maria Bonanni
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.B.); (M.B.); (D.C.)
| | - Aleena Abbasi
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.A.)
| | - Tanaya Oliphant
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.Z.G.); (T.O.); (C.R.)
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.A.)
| | - Christopher Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.Z.G.); (T.O.); (C.R.)
| | - Debbie Cohen
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.B.); (M.B.); (D.C.)
| | - Jason A. Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.Z.G.); (T.O.); (C.R.)
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Yonghong Huan
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.B.); (M.B.); (D.C.)
| |
Collapse
|
5
|
Dengler NF, Pedro MT, Kolbenschlag J. [Interdisciplinary Treatment Of Tumorous And Tumour-Like Lesions Of Peripheral Nerves]. HANDCHIR MIKROCHIR P 2024; 56:11-20. [PMID: 38508203 DOI: 10.1055/a-2250-7772] [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: 03/22/2024] Open
Abstract
Tumorous or tumour-like lesions of peripheral nerves are generally rare, heterogeneous and challenging to diagnose and treat. They may become apparent by a palpable swelling (lump) near nerves, sensory and/or motor deficits, pain to touch or neuropathic pain. In 91% of cases, tumours are benign. The differentiation of entities and their characteristics as well as a function-preserving resection strategy are highly relevant. Misdiagnosis and inadequate treatment can lead to severe deficits and pain syndromes. Benign tumours include schwannomas and neurofibromas, which can occur sporadically but can also be associated with neurogenetic tumour disposition syndromes if they occur more frequently. Rarer benign nerve tumours include perineuriomas, lipomas, aggressive fibrosis (desmoid tumours), paragangliomas and haemangiomas. Ganglion cysts are described as tumour-like lesions. The association of nerve tumours with neurogenetic syndromes and the correct classification of potentially malignant lesions such as MPNST (malignant peripheral nerve sheath tumour) or intermediate stages such as ANNUBPs (atypical neurofibromatous neoplasms with unknown biological potential) pose particular challenges. Interdisciplinarity is highly relevant for clinical treatment and a correct diagnosis. The aim of our work is to provide an overview of the relevant entities, diagnostic evaluation and contemporary treatment strategies based on the current data situation and taking into account the recently published interdisciplinary AWMF S2k guideline "Diagnosis and Treatment of Peripheral Nerve Tumours".
Collapse
Affiliation(s)
- Nora Franziska Dengler
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Theodor Fontane, Bad Saarow, Germany
- Klinik für Neurochirurgie, Helios Klinik Bad Saarow, Germany
| | - Maria Teresa Pedro
- Sektion für Periphere Nervenchirurgie, Klinik für Neurochirurgie, Univeristätsklinikum Ulm am BKH Günzburg, Ulm, Germany
| | - Jonas Kolbenschlag
- Universitätsklinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tubingen, Germany
| |
Collapse
|
6
|
Fu X, Wu J, Lyu J, Chen B, Wang W, Chi F, Yuan Y, Ren D. Microscopic Versus Endoscopic Ear Surgery for Early-Stage Glomus Tympanicum Tumors. EAR, NOSE & THROAT JOURNAL 2024:1455613231222384. [PMID: 38217439 DOI: 10.1177/01455613231222384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
Purpose: Glomus tympanicum tumors are benign primary tumors of the middle ear that can be completely removed using modern surgery. We compared endoscopic ear surgery (EES) to traditional microscopic ear surgery (MES) in terms of the removal of early-stage glomus tympanicum tumors. Methods: We retrospectively reviewed 25 cases treated from 2003 to 2021 that were of Grade I or II based on the Glasscock-Jackson classification system. Overall, 18 cases underwent MES: 8 via trans-tympanic bone and 10 via canal-wall-down or canal-wall-up tympanomastoidectomy (CWDT or CWUT) and 7 underwent EES. We compared surgery durations, the lengths and costs of hospitalization, postoperative complications, and relapse rates between the two groups and among the three specific operation ways. Results: The postoperative follow-up period ranged from 1 to 19 years. There was no between-group difference in operative time or the length or cost of hospitalization. Operative time and cost of hospitalization did not show a statistically significant correlation to the three surgical procedures, whereas it was found that the group of MES via the trans-tympanic bone had shorter length of hospitalization when compared with CWUT or CWDT group. All tumors were completely resected; pulsatile tinnitus improved in all patients, and there was no major complication. Two patients who underwent CWUT or CWDT (one each) relapsed; no patient relapsed in the EES group. Conclusion: MES via the trans-tympanic bone and EES via the ear canal safely and reliably remove early-stage tumors without excessive patient discomfort.
Collapse
Affiliation(s)
- Xiao Fu
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jingfang Wu
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jihan Lyu
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Binjun Chen
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Wuqing Wang
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Fanglu Chi
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Yasheng Yuan
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Dongdong Ren
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| |
Collapse
|
7
|
Daikhes NA, Diab KMA, Pashchinina OA, Mikhalevich AE, Umarov PU, Panina OS. [Simultaneous occurrence of facial neurinoma in internal auditory canal and middle ear paraganglioma in patient. Unusual combination and difficult surgical task]. Vestn Otorinolaringol 2024; 89:69-76. [PMID: 39104276 DOI: 10.17116/otorino20248903169] [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] [Indexed: 08/07/2024]
Abstract
CLINICAL CASE The 59-year-old patient complained of hearing loss on the left, ear murmur for a long time, periodic pain and discomfort in the left ear, dizziness for 6 months. She was found to have concurrent vestibular schwannoma in the internal auditory canal and temporal bone paraganglioma. Both tumors were removed in one operation. The schwannoma was removed by translabirinth access due to preoperative deafness, while the glomus tumor was removed during this access. Postoperative biopsy showed the presence of two unrelated diseases: paraganglioma (ICD-0 code 8690/3) and schwannoma (ICD-0 code 9560/0).
Collapse
Affiliation(s)
- N A Daikhes
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Kh M-A Diab
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O A Pashchinina
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - A E Mikhalevich
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - P U Umarov
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - O S Panina
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| |
Collapse
|
8
|
Sahoo PR, Sahu M, Khan IW, Samantaray K. Glomus tympanicum removal using transcanal endoscopic assisted surgery: An experience with six cases. World J Otorhinolaryngol Head Neck Surg 2023; 9:302-307. [PMID: 38059144 PMCID: PMC10696267 DOI: 10.1002/wjo2.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/28/2022] [Accepted: 03/31/2023] [Indexed: 12/08/2023] Open
Abstract
Objective To evaluate an endoscopic approach in the management of glomus tumor, and also to investigate and evaluate its appropriateness and feasibility. Methods Glomus tumors, also known as paragangliomas, are benign primary tumors of the middle ear. The advent of endoscopic ear surgery has provided new dimensions to the management of this highly vascular tumor. Retrospective analysis of six patients of glomus tympanicum, operated between July 2014 and June 2019, with modified Fisch classification Type A and B1, who were managed by a retroauricular transcanal endoscopic approach. Preoperative and postoperative analysis was done for these patients. Results The chief complaint was pulsatile tinnitus, which disappeared in five cases and reduced in severity in one of them. Hearing was improved with reduction in air-bone gap in all the cases. No major complications or recurrence were observed in any of the patients after 12 months of follow-up. Conclusion This endoscopic approach serves as a safe and reliable technique for tumor removal. It thus provides postoperative comfort for most of the patients.
Collapse
Affiliation(s)
- Pradipt Ranjan Sahoo
- Department of ENT and Head and Neck SurgeryKalinga Institute of Medical SciencesBhubaneswarOdishaIndia
| | - Monalisa Sahu
- Department of Infectious DiseasesYashoda HospitalsHyderabadIndia
| | - Imran Wasfi Khan
- Department of ENT and Head and Neck SurgeryKalinga Institute of Medical SciencesBhubaneswarOdishaIndia
| | - Kabikanta Samantaray
- Department of ENT and Head and Neck SurgeryKalinga Institute of Medical SciencesBhubaneswarOdishaIndia
| |
Collapse
|
9
|
Curry SD, Kocharyan A, Lekovic GP. Multi-Disciplinary Approach to Skull Base Paragangliomas. Brain Sci 2023; 13:1533. [PMID: 38002493 PMCID: PMC10669609 DOI: 10.3390/brainsci13111533] [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: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of skull base paragangliomas has moved towards the use of cranial nerve preservation strategies, using radiation therapy and subtotal resection in instances when aiming for gross total resection would be expected to cause increased morbidity compared to the natural history of the tumor itself. The goal of this study was to analyze the role of surgery in patients with skull base paragangliomas treated with CyberKnife stereotactic radiosurgery (SRS) for definitive tumor control. A retrospective review identified 22 patients (median age 65.5 years, 50% female) treated with SRS from 2010-2022. Fourteen patients (63.6%) underwent microsurgical resection. Gross total resection was performed in four patients for tympanic paraganglioma (n = 2), contralateral paraganglioma (n = 1), and intracranial tumor with multiple cranial neuropathies (n = 1). Partial/subtotal resection was performed for the treatment of pulsatile tinnitus and conductive hearing loss (n = 6), chronic otitis and otorrhea (n = 2), intracranial extension (n = 1), or episodic vertigo due to perilymphatic fistula (n = 1). Eighteen patients had clinical and imaging follow-up for a mean (SD) of 4.5 (3.4) years after SRS, with all patients having clinical and radiological tumor control and no mortalities. Surgery remains an important component in the multidisciplinary treatment of skull base paraganglioma when considering other outcomes besides local tumor control.
Collapse
Affiliation(s)
- Steven D. Curry
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Armine Kocharyan
- House Clinic, Los Angeles, CA 90017, USA
- Department of Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| | - Gregory P. Lekovic
- House Clinic, Los Angeles, CA 90017, USA
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA
| |
Collapse
|
10
|
Surmelioglu O, Bajin MD, Kaya I, Okuyucu S, Ozturk K, Orhan KS, Karlıdag T, Ardıc FN, Ozdek A, Yorgancılar E, Dagkiran M, Celik M. Transcanal Endoscopic Management of Middle Ear Paragangliomas. Otol Neurotol 2023; 44:798-803. [PMID: 37505072 DOI: 10.1097/mao.0000000000003957] [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: 07/29/2023]
Abstract
OBJECTIVE To evaluate the clinical and audiological outcomes of transcanal endoscopic resection of middle ear paragangliomas. STUDY DESIGN Retrospective multicenter study. SETTING Tertiary referral center and private otology clinic. PATIENTS Patients who underwent transcanal endoscopic surgery between January 2015 and September 2020. INTERVENTIONS Transcanal endocope-assisted resection of middle ear paragangliomas. MAIN OUTCOME MEASURES Demographic data. RESULTS Twenty-three patients (2 men, 21 women) with a mean (standard deviation [SD]) age of 50.5 (11.8) years and stage 1 or 2 disease were included in the study. The mean follow-up time was 2.7 years (range, 1-5 yr). Preoperatively, the mean (SD) air-conduction threshold was 33.8 (17.9) dB, and the mean (SD) air-bone gap was 13.1 (13.9) dB. Postoperatively, the mean (SD) air-conduction threshold was 25.7 (10.2) dB, the mean (SD) air-bone gap was 6.3 (6.1) dB. The mean (SD) hospital stay was 27.7 (9.9) hours. No tumor regrowth was detected on magnetic resonance imaging during postoperative follow-up. CONCLUSIONS Endoscopic transcanal tumor resection is effective and feasible in the treatment of stage 1 and 2 tumors and is associated with short operative time, low risk of perioperative and postoperative complications, and rapid discharge.
Collapse
Affiliation(s)
- Ozgur Surmelioglu
- Department of Otorhinolaryngology, Faculty of Medicine, Cukurova University, Adana
| | - Munir Demir Bajin
- Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Ankara
| | - Isa Kaya
- Department of Otorhinolaryngology, Faculty of Medicine, Ege University, İzmir
| | - Semsettin Okuyucu
- Department of Otorhinolaryngology, Faculty of Medicine, Mustafa Kemal University, Hatay
| | - Kayhan Ozturk
- Department of Otorhinolaryngology, Faculty of Medicine, KTO Karatay University, Medicana Konya Hospital, Konya
| | - Kadir Serkan Orhan
- Department of Otorhinolaryngology, Faculty of Medicine, Istanbul University, Istanbul
| | - Turgut Karlıdag
- Department of Otorhinolaryngology, Faculty of Medicine, Fırat University, Elazıg
| | - Fazil Necdet Ardıc
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli
| | | | - Ediz Yorgancılar
- Department of Otorhinolaryngology, Uskudar University, Diyarbakir Memorial Hospital, Diyarbakir, Turkey
| | - Muhammed Dagkiran
- Department of Otorhinolaryngology, Faculty of Medicine, Cukurova University, Adana
| | - Mehmet Celik
- Department of Otorhinolaryngology, Faculty of Medicine, Istanbul University, Istanbul
| |
Collapse
|
11
|
Rahmani Z, Khajavi M, Bazgir N, Kordjazi M. A rare presentation of head and neck Paragangliomas in parotid gland: A case report. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100441] [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
|
12
|
A dosimetric comparison of proton versus photon irradiation for paediatric glomus tumour: a case study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Intensity-modulated radiation therapy (IMRT) has revolutionised the way head and neck cancers can be treated. It allows for a more conformal treatment plan when compared to 3D conformal radiation therapy. In paediatric patients, however, IMRT continues to deliver higher doses than desirable. Proton beam therapy on the other hand has the potential to further spare organs-at-risk.
Methods:
A 16-year-old boy with a left-sided paraganglioma of the left base of skull manifested by headaches, neck pain and tongue cramping was simulated, planned and treated with proton therapy with significant contralateral organ-at-risk sparing.
Results:
For this patient, dosimetric plan comparison between photon and proton plans clearly showed better sparing of contralateral organs-at-risk with protons. The contralateral parotid gland received a mean dose of 386·3 cGy with photons, whereas it received 1·3 cGy (CGE) in the proton plan.
Conclusions:
The dosimetric advantage of proton beam over photon beam therapy has successfully been demonstrated in this case study for a paediatric patient with a head and neck tumour. Sparing of contralateral structures is especially important in paediatric patients who are at a greater risk of secondary malignancies due to possible long life expectancy.
Collapse
|
13
|
Harley RJ, Lee JH, Ostrander BT, Finegersh A, Pham TB, Tawfik KO, Ren Y, Faraji F, Friedman RA. Local Tumor Behavior Associated With Survival Among Patients With Paraganglioma of the Head and Neck. OTO Open 2022; 6:2473974X221086872. [PMID: 35571573 PMCID: PMC9096223 DOI: 10.1177/2473974x221086872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this study was to evaluate the utility of
ICD-O-3–classified local tumor behavior as a
prognosticator of head and neck paraganglioma (HNP) outcomes. Study Design Retrospective cohort study. Setting National Cancer Database between 2004 and 2016. Methods This study included patients aged ≥18 years who were diagnosed with HNP.
Clinical outcomes and clinicopathologic features were compared with regard
to local tumor behavior. Results Our study included 525 patients, of which the majority had HNP classified as
locally invasive (45.9%) or borderline (37.9%). The most common anatomic
sites involved were the carotid body (33.7%), intracranial regions (29.0%),
or cranial nerves (25.5%). Carotid body tumors were exclusively locally
invasive, whereas intracranial and cranial nerve HNP were overwhelmingly
benign or borderline (94% and 91%, respectively). One-fourth of patients
underwent pathologic analysis of regional lymph nodes, of which the majority
were positive for metastasis (80.6%). Metastasis to distant organs was twice
as common in patients with locally invasive tumors vs benign (15% vs 7.1).
For benign disease, surgery with radiotherapy (adjusted hazard ratio [aHR],
40.45; P = .006) and active surveillance (aHR, 24.23;
P = .008) were associated with worse survival when
compared with surgery alone. For locally invasive tumors, greater age (aHR,
1.07; P < .0001) and positive surgical margins (aHR,
4.13; P = .010) were predictors of worse survival, while
combined surgery and radiotherapy were predictors of improved survival vs
surgery alone (aHR, 0.31; P = .027). Conclusion While criteria for tumor behavior could not be defined, our results suggest
that such a classification system could be used to enhance HNP risk
stratification and guide clinical management decisions.
Collapse
Affiliation(s)
- Randall J. Harley
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason H. Lee
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Benjamin T. Ostrander
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Andrey Finegersh
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Tammy B. Pham
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Kareem O. Tawfik
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Yin Ren
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Farhoud Faraji
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Rick A. Friedman
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California, USA
| |
Collapse
|
14
|
Lee SJ, Lee SY, Choi BY, Koo JW, Hong SH, Song JJ. Preoperative Significance of Ipsilateral Manual Neck Compression in Patients With Pulsatile Tinnitus Secondary to Sigmoid Sinus Dehiscences and Diverticula. Front Neurol 2022; 13:869244. [PMID: 35370915 PMCID: PMC8968956 DOI: 10.3389/fneur.2022.869244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Venous pulsatile tinnitus (PT) is characterized by an auditory perception of pulse-synchronous sound, suppressed by compression of the ipsilateral internal jugular vein. We sought to determine the preoperative prognostic significance of the effect of ipsilateral neck manual compression on the PT loudness and audiometric changes in patients with sigmoid sinus dehiscences (SS-Deh) and diverticula (SS-Div) by comparing postoperative improvements in ipsilateral low-frequency hearing loss (LFHL) in pure-tone audiogram (PTA) and PT symptoms. Twenty-two subjects with PT originating from SS-Deh/Div were recruited. Air-conduction hearing thresholds were measured using PTA at three time points: twice preoperatively (with neutral neck position and with ipsilateral manual compression of internal jugular vein) and once at 3-months postoperatively with neutral neck position. We defined a positive neck compression effect as a threshold improvement of ≥ 10 dB HL at 250 or 500 Hz after manual neck compression. All but two subjects presented with ipsilateral LFHL in the neutral position. The average hearing threshold in the neutral position markedly improved after manual neck compression, indicating that LFHL originated from the masking effect of venous PT. All subjects had subjective improvements in PT and LFHL after sigmoid sinus surgeries, confirming that LFHL resulted from the masking effect of PT. Additionally, improvement of LFHL after neck compression could be regarded as a positive prognostic indicator after surgery. Collectively, elimination of PT loudness and improvement of LFHL with manual compression over the ipsilateral neck may suggest the venous origin of the PT and predict a favorable outcome following repair of SS-Deh/SS-Div.
Collapse
Affiliation(s)
- Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Hwa Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
- *Correspondence: Jae-Jin Song ;
| |
Collapse
|
15
|
de Souza SNF, Pongeluppi RI, Cardoso RAM, Abud DG, Colli BO, Massuda ET, de Oliveira RS. Glomus jugulare in a pediatric patient: case report and literature review. Childs Nerv Syst 2022; 38:269-277. [PMID: 34698910 DOI: 10.1007/s00381-021-05397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The jugular and tympanic glomus are rare neoplasms in the general population, being even more uncommon in the pediatric population. There is considerable morbidity associated with both disease and treatment. Treatment is essentially surgical, carried out in recent years in a multidisciplinary manner using preoperative embolization associated with microsurgery and eventually adjuvant radiotherapy. The outcome depends on the location of the lesion and its proximity to noble structures in addition to multidisciplinary monitoring in the postoperative period. METHODS In this article, a literature review was carried out in the PubMed database, finding reports from 17 patients diagnosed with the disease. Only articles in English were considered. RESULTS Moreover, we reported a case of a 14-year-old patient diagnosed with jugulotympanic glomus who underwent radical surgical treatment of the lesion. CONCLUSION This is a rare case of jugulotympanic glomus in a pediatric patient, who underwent surgical treatment associated with multidisciplinary therapy, with a favorable postoperative outcome.
Collapse
Affiliation(s)
- Stephanie Naomi Funo de Souza
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Rodrigo Inácio Pongeluppi
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Rodrigo Augusto Monteiro Cardoso
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| | - Eduardo Tanaka Massuda
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil
| |
Collapse
|
16
|
Patel EJ, Deep NL, Liu CZ, Jethanamest D. Endoscopic Transcanal and Transmastoid Laser-Assisted Resection of Middle Ear Capillary Hemangioma. Otol Neurotol 2022; 43:90-93. [PMID: 34711778 DOI: 10.1097/mao.0000000000003386] [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: 11/25/2022]
Abstract
OBJECTIVE To present a rare case of a middle ear capillary hemangioma in an adult. PATIENT A 31-year-old woman with a 6-month history of left ear fullness, pressure, tinnitus, and progressive hearing loss. INTERVENTION Endoscopic laser-assisted resection. MAIN OUTCOME MEASURES Clinical, radiographic, and histopathological findings of a capillary hemangioma. RESULTS Otoscopy revealed an erythematous and slightly pulsating multilobulated middle ear retrotympanic mass. Her audiogram demonstrated a left-sided mixed hearing loss with air-conduction thresholds in the severe-to-profound range. Computed tomography (CT) imaging was significant for total opacification of the left middle ear and mastoid air cells. She underwent a combined endoscopic transcanal and transmastoid excision of the mass with ossicular chain reconstruction. A KTP laser was used to ablate and shrink down the periphery of the lesion. Pathology of the specimen was consistent with a capillary hemangioma. The patient's pulsatile tinnitus and spontaneous vertigo resolved postoperatively. CONCLUSIONS Capillary hemangiomas are an uncommon cause of vascular middle ear lesions in adults and typically present with symptoms of aural fullness, pulsatile tinnitus, conductive hearing loss, otalgia, and vertigo. Surgery resection provides definitive treatment and the use of laser ablation techniques can allow for hemostasis and excellent visualization.
Collapse
Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head & Neck Surgery
| | | | - Cheng Z Liu
- Department of Pathology, NYU School of Medicine, New York, New York
| | | |
Collapse
|
17
|
Garov EV, Kryukov AI, Zelikovich EI, Kurilenkov GV, Moseykina LA, Zelenkova VN, Mishchenko VV, Omarova MM. [A case of obliteration of a round window in otosclerosis]. Vestn Otorinolaringol 2021; 86:75-81. [PMID: 34783478 DOI: 10.17116/otorino20218605175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents a brief review of the literature on the anatomy and physiology of the round window (RW) niche, the causes of occlusion, the diagnosis of this pathology, the features of auditory disorders and tactics when it is detected in patients with otosclerosis (OS). A clinical case of diagnosis and effective surgical treatment for obliteration of RW in a patient with advanced OS, which occurred in 2019 in 0.7% of cases, is described. Removal of RW niche obliteration was carried out with a curette and microcresis by smoothing the canopy over RW until partial visualization of the secondary membrane. It was this stage of the operation that made it possible to restore the normal hydrodynamics of the inner ear fluids and contributed to a functional result. Thus, the diagnosis of RW obliteration in patients with OS is difficult, but possible when using computed tomography of the temporal bones and assessing the mobility of the RW membrane or analyzing changes in hearing at the end of the operation, if it is performed under local anesthesia. The simultaneous performance of stapedoplasty and the removal of bone obliteration of RW makes it possible to safely achieve functional rehabilitation in patients with OS.
Collapse
Affiliation(s)
- E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Zelikovich
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G V Kurilenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - L A Moseykina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V N Zelenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V V Mishchenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M M Omarova
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
18
|
Endoscopic Management of Early Stage Middle Ear Paragangliomas - An Australian Case Series. Otol Neurotol 2021; 42:e1677-e1682. [PMID: 34121083 DOI: 10.1097/mao.0000000000003234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the outcomes of the endoscopic transcanal approach for removal of early stage middle ear paraganglioma tumors (MEPT). STUDY DESIGN Cases series with chart review. SETTING Two tertiary Australian Otology centers. PATIENTS Adult patients with middle ear paraganglioma tumors treated with transcanal endoscopic approach from 2/2016 to 12/2019. Tumor staging was described using the Modified Fisch-Mattox (MFM). Inclusion criteria included patients with an MFM Class A or B. Exclusion criteria included higher staged or syndromic disease. INTERVENTION All tumors were managed with transcanal endoscopic approach. MAIN OUTCOME MEASURES Primary outcome measures included disease clearance and hearing measured according to the AAO-HNS guidelines. Secondary outcomes included complications, duration of surgery, and length of stay. RESULTS Ten patients underwent totally endoscopic transcanal resection of MEPT (9 female, mean age of 45.5 years, 70% were left sided). Mean tumor size was 6.1 mm (SD 3.4 mm). Five cases (50%) were classified using the MFM system as class A1, two cases were class A2, and three cases were class B1. Three cases required canalplasty for access but were completed entirely endoscopically. Nine of the 10 cases had complete audiometric data. Pre- and postoperative mean air conduction remained stable with a decrease in mean air-bone gap of 2.84 dB. Postoperative complications include one pinhole perforation. There were no facial nerve complications. Mean follow-up period was 10 months (range 4-25 mo) with all cases having resolution of pulsatile tinnitus and no tumor recurrence. CONCLUSION The transcanal endoscopic approach for early stage MEPT offers excellent visualization and permits safe and effective removal of disease with the advantages of a minimally invasive technique for patient recovery.
Collapse
|
19
|
Lee SJ, Lee SY, An GS, Lee K, Choi BY, Koo JW, Song JJ. Treatment Outcomes of Patients with Glomus Tympanicum Tumors Presenting with Pulsatile Tinnitus. J Clin Med 2021; 10:2348. [PMID: 34071897 PMCID: PMC8198089 DOI: 10.3390/jcm10112348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
We reviewed the clinical characteristics and treatment outcomes of patients with glomus tympanicum tumors (GTTs) presenting with pulsatile tinnitus (PT). We explored whether transcanal sound recording-spectro-temporal analysis (TSR-STA) usefully evaluated changes in PT. The medical records of 13 patients who underwent surgical removal of GTTs were reviewed retrospectively. Two patients underwent preoperative endovascular embolization. Changes in PT, pre- and postoperative audiometry data, TSR-STA results, and clinical outcomes were evaluated. PT was the chief complaint in eight patients (61.5%) and resolved immediately after surgical intervention in all. Two patients exhibited ipsilateral, pseudo-low-frequency hearing loss (PLFHL); surgical GTT removal elicited postoperative improvements in the ipsilesional low-frequency hearing thresholds. Five patients underwent TSR-STA using previously described methods. TSR-STA revealed definite rise-and-fall patterns; surgical tumor removal abated this pattern in one patient, but, for the other four, the patterns did not change greatly post-intervention. Thus, GTT-related PT can be treated successfully (via surgical GTT removal) without complications. In selected cases, preoperative embolization reduces intraoperative hemorrhage. In PT patients with PLFHL, a detailed otoendoscopic examination of the middle ear is required to rule out a GTT. TSR-STA may usefully (and objectively) assess postoperative improvements in GTT-related PT.
Collapse
Affiliation(s)
- Seung-Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea;
| | - Gwang-Seok An
- Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Gwanak-gu, Seoul 08826, Korea; (G.-S.A.); (K.L.)
| | - Kyogu Lee
- Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Gwanak-gu, Seoul 08826, Korea; (G.-S.A.); (K.L.)
| | - Byung-Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea; (S.-J.L.); (B.-Y.C.); (J.-W.K.)
| |
Collapse
|
20
|
Abstract
OBJECTIVE The aim of this study was to report a multicentric surgical experience in the exclusive endoscopic management of glomus tympanicum (GT). STUDY DESIGN Retrospective case series review at two institutions. SETTING Tertiary referral centers. PATIENTS The study included 30 patients who underwent exclusive transcanal excision of GT between 2010 and 2017 at the two referral centers. INTERVENTIONS Exclusive endoscopic transcanal excision of GT type A1, A2, and B1 (modified Fisch-Mattox classification). All surgical procedures were performed by two senior surgeons (L.P.; M.B.). MAIN OUTCOME MEASURES For each procedure, intraoperative features of the disease, postoperative complications, and functional outcomes were evaluated. Recurrent or residual diseases were clinically and radiologically assessed during the follow-up period. RESULTS None of the patients treated with transcanal endoscopic approach (TEA) experienced intraoperative complications, nor required conversion to microscopic approach. Gross total resection (GTR) was obtained in 90% of the cases, while a near total resection was advocated when the residual pathology had a close relationship with the internal carotid artery. Mean hospitalization time was 1.6 (±0.8 SD) days and no postoperative complications were reported. No recurrences were reported in the GTR group after a mean follow-up period of 38.1 (±28.7 SD) months. CONCLUSIONS Middle ear paragangliomas with no mastoid involvement (Class A1, A2, and B1) can be safely managed by means of a transcanal endoscopic approach. Low rate of postoperative complications, short hospitalization, and high rate of gross total resection demonstrate that TEA is a safe and effective procedure.
Collapse
|
21
|
Nair S, Brijith K, Aishwarya J, Pavithra V. Transcanal endoscopic excision of tympanic paraganglioma: A three-case series. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
22
|
Li XX, Cui WN, Gao GD. Vertigo as the sole complaint of tympanomastoid paraganglioma. J Otol 2020; 15:33-35. [PMID: 32110238 PMCID: PMC7033595 DOI: 10.1016/j.joto.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 11/26/2022] Open
Abstract
Background Tympanomastoid paragangliomas are usually benign, slowly growing, painless tumors. The common presenting symptoms of this tumor are pulsatile tinnitus and conductive hearing loss. Vertigo as the cardinal or initial symptom is extremely are, especially in the early stages of the disease. Case presentation A 53-year-old female patient presented only with intermittent recurrent vertigo and was later found to have a tympanomastoid paraganglioma. Her symptoms disappeared completely after resection of the tumor. This is the first report in literature of a case of tympanomastoid paraganglioma with vertigo as the single symptom. Conclusion The tympanomastoid paraganglioma is rare and its clinical symptoms are nonspecific, so it is easy to be misdiagnosed or missed. It is worth noting that although clinically uncommon, vertigo can also be the first or sole symptom of tympanomastoid paraganglioma. Detailed physical examination and imaging examination of the ear are necessary and should be carried out meticulously.
Collapse
Affiliation(s)
- Xi-Xing Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei-Na Cui
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guo-Dong Gao
- Department of Medical Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
23
|
Benson JC, Diehn F, Passe T, Guerin J, Silvera VM, Carlson ML, Lane J. The Forgotten Second Window: A Pictorial Review of Round Window Pathologies. AJNR Am J Neuroradiol 2019; 41:192-199. [PMID: 31831467 DOI: 10.3174/ajnr.a6356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/02/2019] [Indexed: 12/26/2022]
Abstract
The round window serves to decompress acoustic energy that enters the cochlea via stapes movement against the oval window. Any inward motion of the oval window via stapes vibration leads to outward motion of the round window. Occlusion of the round window is a cause of conductive hearing loss because it increases the resistance to sound energy and consequently dampens energy propagation. Because the round window niche is not adequately evaluated by otoscopy and may be incompletely exposed during an operation, otologic surgeons may not always correctly identify associated pathology. Thus, radiologists play an essential role in the identification and classification of diseases affecting the round window. The purpose of this review is to highlight the developmental, acquired, neoplastic, and iatrogenic range of pathologies that can be encountered in round window dysfunction.
Collapse
Affiliation(s)
- J C Benson
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - F Diehn
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - T Passe
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - J Guerin
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - V M Silvera
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - J Lane
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| |
Collapse
|
24
|
Petrović F, Stojanov D, Živković N, Zdravković J, Petrović M, Milisavljević D, Radovanović Z. GLOMUS TYMPANICUM PARAGANGLIOMA IN A 63-YEAR-OLD MALE - A RARE ENTITY IN THE MIDDLE EAR: A CASE REPORT. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
25
|
Noel JE, Sajjadi H. KTP-laser-assisted endoscopic management of glomus tympanicum tumors: A case series. EAR, NOSE & THROAT JOURNAL 2019; 97:399-402. [PMID: 30540890 DOI: 10.1177/014556131809701209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endoscopic technology is widely used in rhinology and anterior skull base surgery, but it has been less quickly incorporated into otologic practice. The design of the instrumentation forces surgeons to work one-handed and limits depth perception. Nevertheless, endoscopy also offers wide fields of view and access to spaces that are typically difficult to visualize. Its advantages have broadened the type and extent of operations that can be performed via the ear canal. We describe a method of endoscopic resection of glomus tympanicum tumors in 5 adults who had undergone endoscopic or endoscopy- assisted resection. A successful resection was achieved in all patients-exclusively via the ear canal in 4 of them. A KTP laser was used to address the tumor's vascular supply. Attachment of a neonatal feeding tube to the endoscope for use as a suction catheter obviated the need to repeatedly switch instruments while using the laser. At a minimum of 12 months of follow-up, all patients were free of recurrence. Postoperative audiometry detected no significant adverse hearing outcomes in any patient. We conclude that the minimally invasive endoscopic transcanal approach is a feasible technique for addressing middle ear tumors. We have also developed a method that allows surgeons constant use of the KTP laser to resect a glomus tympanicum tumor.
Collapse
Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Stanford, CA 94035, USA.
| | | |
Collapse
|
26
|
Isaacson B, Wick CC, Perez C, Cantrell SC, Killeen DE. Pathophysiology of sensorineural hearing loss in jugular foramen paraganglioma. Laryngoscope 2018; 129:67-75. [PMID: 30194736 DOI: 10.1002/lary.27343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Pathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma. STUDY DESIGN Retrospective case-control study. METHODS The presenting audiograms, magnetic resonance imaging, and computed tomography were reviewed in 46 subjects with jugular foramen paragangliomas. Four-frequency bone conduction average was compared between the tumor and nontumor ears in each subject to establish the presence of sensorineural hearing loss. Imaging findings for each subject were recorded. Univariate and multivariate statistical analyses were performed to determine which radiographic features were associated with sensorineural hearing loss. Hearing data were analyzed as a continuous variable and as a categorical variable. RESULTS Twenty subjects (43.4%) had a bone-conduction pure-tone asymmetry of greater than 15 dB. Inferior cochlear vein involvement was identified in 19 of the 20 (95%) subjects with sensorineural hearing loss. Inferior cochlear vein involvement was found to be a statistically significant predictor of sensorineural hearing loss using univariate and multivariate analyses. Other imaging findings that were statistically significant predictors of sensorineural hearing loss include Glasscock-Jackson stage, Fisch-Mattox stage, hypoglossal canal involvement, jugulo-carotid spin erosion, and petrous carotid canal erosion. CONCLUSIONS Involvement of the inferior cochlear vein appears to be a plausible mechanism for sensorineural hearing loss in patients with jugular foramen paraganglioma. LEVEL OF EVIDENCE 4 Laryngoscope, 129:67-75, 2019.
Collapse
Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Carlos Perez
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Sarah C Cantrell
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| |
Collapse
|
27
|
Adenomatous Neuroendocrine Tumors of the Middle Ear: A Multi-institutional Investigation of 32 Cases and Development of a Staging System. Otol Neurotol 2018; 39:e712-e721. [DOI: 10.1097/mao.0000000000001905] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Paragangliomas of the Head and Neck: An Overview from Diagnosis to Genetics. Head Neck Pathol 2017; 11:278-287. [PMID: 28321772 PMCID: PMC5550402 DOI: 10.1007/s12105-017-0803-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 10/19/2022]
Abstract
Paragangliomas (PGL) develop from the parasympathetic system in the head and neck (HN) and arise primarily in four distinct areas: Carotid body, vagal, middle ear, and larynx. Globally, the diagnosis and morphologic features are the same regardless of anatomic site, however the incidence, frequency of genetic alterations/syndromes and differential diagnosis vary. It is now recognized that nearly 40% of all HN PGLs are hereditary, including a significant subset without a known family history. Now pathologists are central to the evaluation for diagnosis and further management of patients with HNPGLs. Specifically, SDHB immunohistochemical evaluation is an excellent screening tool to detect tumors with alterations in the SDH family of genes that represent the majority of hereditary cases in HNPGL. Similarly, SDHB immunohistochemical analysis allows for screening of PGL syndrome associated tumors (gastrointestinal stromal tumor (GIST), renal cell carcinoma (RCC), and pituitary adenomas) that have now been linked by their overlapping gene alterations. Awareness of the spectrum of these syndromes, and their associated tumors, positions the pathologist to augment patient care and surveillance.
Collapse
|
29
|
|
30
|
Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Paragangliomas. Head Neck Pathol 2017; 11:88-95. [PMID: 28247224 PMCID: PMC5340727 DOI: 10.1007/s12105-017-0786-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/02/2017] [Indexed: 01/17/2023]
Abstract
Updated editions of The World Health Organization Classification of Tumours Pathology & Genetics for both Head and Neck Tumours and Tumours of Endocrine Organs took place in 2016 based on consensus conferences. These editions present unification of concepts in paragangliomas and highlight expanding knowledge of their etiology. There is a major emphasis in the new bluebooks on familial/syndromic paragangliomas, representing ~40% of all head and neck paragangliomas. Ancillary use of immunohistochemical evaluation, specifically of SDHB, allows the pathologist to screen for a large subset of these potentially hereditary cases. In addition, similarly to other neuroendocrine tumors, paragangliomas are now considered to represent a continuum of risk, and are assessed in terms of risk stratification. Tumors with SDHB mutations pose the highest risk for metastasis. There is currently no validated or endorsed histologic grading system. Paragangliomas remain tumors of undetermined biologic potential and should not be termed benign.
Collapse
|
31
|
Düzlü M, Tutar H, Karamert R, Karaloğlu F, Şahin MM, Göcek M, Uğur MB, Göksu N. Temporal bone paragangliomas: 15 years experience. Braz J Otorhinolaryngol 2016; 84:S1808-8694(16)30235-X. [PMID: 28011121 PMCID: PMC9442861 DOI: 10.1016/j.bjorl.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/08/2016] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Temporal bone paragangliomas (TBPs) are benign tumors arising from neural crest cells located along the jugular bulbus and the tympanic plexus. In general surgical excision, radiotherapy and wait-and-scan protocols are the main management modalities for TBPs. OBJECTIVE In this paper we aim to present our clinical experience with TBPs and to review literature data. METHODS The patients who were operated for tympanomastoid paraganglioma (TMP) or tympanojugular paraganglioma (TJP) in our clinic in the last 15 years were enrolled in the study. A detailed patient's charts review was performed retrospectively. RESULTS There were 18 (52.9%) cases with TMPs and 16 (47.1%) cases with TJPs, a total of 34 patients operated for TBPs in this time period. The mean age was 50.3± 11.7 (range 25-71 years). The most common presenting symptoms were tinnitus and hearing loss for both TMPs and TJPs. Gross total tumor resection was achieved in 17 (94.4%) and 10 (62.5%) cases for TMPs and TJPs, respectively. Five patients (31.2%) with TJP experienced facial palsy following the operation. For all the patients the mean follow-up period was 25.8 months (range 4-108 months). CONCLUSION In conclusion, based on our findings and literature review, total surgical excision alone or with preoperative embolization is the main treatment modality for TBPs. However radiotherapy, observation protocol and subtotal resection must be considered in cases of preoperative functioning cranial nerves, large tumors and advanced age.
Collapse
Affiliation(s)
- Mehmet Düzlü
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Hakan Tutar
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Recep Karamert
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Furkan Karaloğlu
- Ankara Occupational Diseases Hospital, ENT Clinic, Ankara, Turkey
| | - Muammer Melih Şahin
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Mehmet Göcek
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Mehmet Birol Uğur
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Nebil Göksu
- Gazi University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| |
Collapse
|
32
|
O'Connell BP, Hunter JB, Carlson ML, Isaacson B, Rivas A, Wanna GB. Utility of an Ultrasonic Aspirator in Transcanal Endoscopic Resection of Temporal Bone Paraganglioma. J Neurol Surg B Skull Base 2016; 78:96-98. [PMID: 28180050 DOI: 10.1055/s-0036-1585090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to evaluate the role of removing middle ear paragangliomas using an ultrasonic aspirator (UA) through a transcanal, exclusively endoscopic approach. Three consecutive patients undergoing transcanal endoscopic resection of middle ear paragangliomas using an UA were retrospectively studied. The primary outcome measure was achieving gross total tumor resection. Secondary outcomes included postoperative hearing and early convalescence. Two glomus tympanicum tumors and one small glomus jugulare were included, and complete tumor resection was achieved endoscopically in all cases. All patients demonstrated intact tympanic membranes and normal facial nerve function at the initial postoperative visit. There were no cases of bone-conduction pure tone threshold increases of more than 15 dB. The UA was helpful when performing exclusively endoscopic transcanal resection of middle ear paraganglioma given its simultaneous suction-aspiration capability.
Collapse
Affiliation(s)
- Brendan P O'Connell
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jacob B Hunter
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Matthew L Carlson
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Brandon Isaacson
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Alejandro Rivas
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - George B Wanna
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States; Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| |
Collapse
|
33
|
Abstract
Tantamount to the management of temporal bone neoplasms is the ability to visualize the pathology and its relationship with the numerous critical structures housed therein. Transcanal endoscopic ear surgery provides the surgeon with an unparalleled view of the entire middle ear. This article presents the latest information on the usefulness of transcanal endoscopic ear surgery in the management of middle ear and temporal bone neoplasms.
Collapse
Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
| | | |
Collapse
|
34
|
Chung DH, Kim NR, Kim T, Ahn J, Lee S, Lee YD, Cho HY. Malignant glomus tumor of the thyroid gland where is heretofore an unreported organ: a case report and literature review. Endocr Pathol 2015; 26:37-44. [PMID: 25544269 DOI: 10.1007/s12022-014-9352-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Glomus tumors are relatively uncommon clinically benign tumors. Malignant glomus tumors are rare, and only a small number develop metastatic foci. The usual location is deep dermis or subcutis, but it has been reported in various locations. A 55-year-old man presented with an incidentally found thyroid mass. Neck ultrasound showed a mass with a heterogeneous hypoechoic calcific mass in the right lobe. Right lobectomy specimen showed the 3.6-cm-sized calcified mass composed of sheets of uniform round to polygonal cells and intervening staghorn-shaped vessels. Occasional cellular atypism and necrosis with increased mitotic activity (up to 7 per 10 high-power fields) were found. Infiltration to the residual thyroid parenchyma, vessel, thyroidal capsule, and strap muscle was found. These tumor cells were strongly positive for smooth muscle actin, collagen type IV, and vimentin with pericellular reticulin-cuffing. Ultrastructurally, closely packed oval-shaped tumor cells having cytoplasmic mitochondria, rough endoplasmic reticulums with pinocytotic vesicles along the plasmalemmal surface and thin filaments of 6 nm in diameter were surrounded by thick basal lamina. That mass was diagnosed as a malignant glomus tumor. Incidentally, a 0.5-cm-sized papillary carcinoma was found through entire embedding. Complete thyroidectomy with chemotherapy was done. Thirty months later, multiple metastases developed in the brain and lung, and he expired. To our knowledge, neither benign nor malignant thyroid glomus tumor has been previously described. Here, we describe the first case of a malignant glomus tumor in the thyroid gland.
Collapse
Affiliation(s)
- Dong Hae Chung
- Department of Pathology, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil Namdong-gu, Incheon, 405-760, Korea
| | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Glomus tympanicum (GT) tumors are benign arising from paraganglion cells of the tympanic plexus in the middle ear. Although surgical resection remains the best option for definitive treatment of these tumors, the diagnostic and management algorithms have evolved considerably with the introduction of high-resolution computed tomography, MRI, and genetic testing.
Collapse
|