A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report

A Rapidly Progressing Carotid Body Tumor: A Case Report

Carotid body tumors (CBTs) are a rare form of paragangliomas that often arise near the carotid bifurcation. They are typically slow growing and often asymptomatic. We report a case of a CBT in a 70-year-old man, who presented with a firm, painless, pulsatile neck mass that rapidly increased in size over the course of two months. The diagnosis was suspected based on the patient's clinical history and physical examination. The diagnosis was confirmed with CT angiography (CTA). The tumor was nonfunctioning based on normal urinary-free catecholamines, vanillylmandelic acid (VMA), and metanephrines levels. The patient then underwent a CT scan of his thorax, abdomen, and pelvis which did not detect any metastatic spread. The patient was referred to a tertiary vascular surgery center for definitive treatment. Our aim in presenting this case is to increase awareness of this rare type of paraganglioma with the hope of increasing early intervention and improving outcomes.

Carotid Body Tumor Microenvironment

Carotid body tumors (CBTs) are rare paragangliomas, comprising 0.5% of all head and neck tumors, and 65% of head and neck paragangliomas. A majority of CBTs occur sporadically, while 15% are familial or hyperplastic in the setting of chronic hypoxia. They usually present as unilateral, well-circumscribed rubbery masses, arising at the level of the carotid bifurcation. A majority of CBTs are painless and therefore may evade diagnosis for months to years. Symptomatic lesions occur due to progressive cranial nerve IX, X, or XII dysfunction, manifesting as hoarseness, dysphagia, vertigo, coughing, or odynophagia. Other local symptoms include neck discomfort, pulsatile tinnitus, hearing loss, or carotid sinus syndrome. Appropriate workup includes a thorough physical exam followed by radiographic imaging, vascular studies, and biochemical workup with 24 h urinary catecholamine or metanephrine analysis. The management of these tumors, which involves standalone surgical resection or following embolization for larger and more vascular tumors, will also be discussed.

An ectopic paraganglioma supplied by the subclavian artery in the right supraclavicular fossa

Paragangliomas are rare and highly vascularized neuroendocrine tumors originating from neural crest-derived paraganglionic tissue surrounding the autonomic nerve. In this case, we report a nonfunctional paraganglioma located in the right supraclavicular fossa. Both computed tomography and paraffin-embedded sections diagnosed paraganglioma. The paraganglioma was presumed to be derived from the paraganglia of the right cervical parasympathetic nerve and primarily supplied by the right subclavian artery. Because of the abundant blood supply, we performed arterial embolization before the operation. This ectopic paraganglioma is considered a rare report of a paraganglioma supplied by the subclavian artery.