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Tănăsescu MD, Popescu Ș, Mincă A, Isac T, Suliman E, Grigorie MM, Suliman E, Stăniloaie D, Timofte D, Ionescu D. Paragangliomas and Anemia: Literature Review and Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1925. [PMID: 38003974 PMCID: PMC10673208 DOI: 10.3390/medicina59111925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023]
Abstract
Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, i.e., small organs consisting mainly of neuroendocrine cells that are derived from the embryonic neural crest and have the ability to secrete catecholamines. Paragangliomas can derive from either parasympathetic or sympathetic paraganglia. Most of the parasympathetic ganglia-derived paragangliomas are nonfunctional, and symptoms result from mass effect. Conversely, the sympathetic paragangliomas are functional and produce catecholamine. Although such patients could have symptoms similar to pheochromocytoma, mass effect symptoms, or non-specific symptoms, being benign tumors, they can also present with anemia, specifically iron-deficiency anemia. Considering that neoplastic pathology is chronically accompanied by moderate, normochromic, normocytic anemia, association between paragangliomas that are mostly benign but with a potential degree of malignancy and anemia is not as frequent as expected, with only 12 cases reported in the literature. We report a case of a 54-year-old female patient diagnosed with a paraganglioma of the carotid glomus accompanied by severe normochromic, normocytic anemia, which reached normal limits after excision of the paraganglioma.
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Affiliation(s)
- Maria-Daniela Tănăsescu
- Department 1 of Medical Semiology, Discipline of Medical Semiology and Nephrology, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania; (M.-D.T.); (D.I.)
- Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Ștefan Popescu
- Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Alexandru Mincă
- Department 1 of Medical Semiology, Discipline of Medical Semiology and Nephrology, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania; (M.-D.T.); (D.I.)
| | - Teodora Isac
- Department 2 of Internal Medicine, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Emel Suliman
- Department 10 of General Surgery, Discipline of Surgery I, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.S.); (D.S.)
| | - Maria Mihaela Grigorie
- Department 3 of Dentistry III, Discipline of Endodontics, Faculty of Dentistry, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Emine Suliman
- Department 3 of Complementary Sciences, Discipline of Medical Informatics and Biostatistics, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Daniel Stăniloaie
- Department 10 of General Surgery, Discipline of Surgery I, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.S.); (D.S.)
- 21st Department of General Surgery, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Delia Timofte
- Department of Dialysis, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Dorin Ionescu
- Department 1 of Medical Semiology, Discipline of Medical Semiology and Nephrology, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania; (M.-D.T.); (D.I.)
- Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
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Nashnoush M, Lad M, Masood I, Singh A, Sazzad S, Bharmal S, Negussie M, Marwan M, Eskander S. Multiparametric analysis of carotid body tumours: a pictorial essay. J Ultrasound 2023; 26:553-561. [PMID: 36114987 PMCID: PMC10247662 DOI: 10.1007/s40477-022-00711-1] [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: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Carotid body tumours (CBT), also called carotid body paraganglioma, are highly vascular and histologically portray paraganglion cells. They are typically found at the carotid bifurcation and result in the splaying of the internal and external carotid arteries (ICA and ECA). Recent literature supports the role of chronic hypoxia in the etiology of CBT. This pictorial essay discusses how CBT is an uncommon etiology for common clinical problems such as transient ischemic attacks. It also discusses imaging techniques to precisely map out the tumour for surgical resection using advanced imaging modalities and techniques.
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Affiliation(s)
- Mohamed Nashnoush
- School of Health Sciences, Dalhousie University, 1278 Tower Road, Halifax, NS, B3H 2Y7, Canada.
| | - Mrinal Lad
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Isha Masood
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Arjun Singh
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Sadman Sazzad
- Alumni of Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Sidra Bharmal
- Faculty of Science, University of Western Ontario, London, ON, Canada
| | - Michael Negussie
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Menna Marwan
- Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Sherry Eskander
- Department of Biology, University of Toronto, Toronto, ON, Canada
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Srinivasan VM, Labib MA, Rutledge C, Catapano JS, Graffeo CS, Albuquerque FC, Lawton MT. Resection of a Left Carotid Body Tumor With Preoperative Embolization: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00638. [PMID: 36847521 DOI: 10.1227/ons.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/02/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Ramos A, Carnevale JA, Majeed K, Kocharian G, Hussain I, Goldberg JL, Schwarz J, Kutler DI, Knopman J, Stieg P. Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients. J Neurosurg 2023; 138:95-103. [PMID: 35523262 DOI: 10.3171/2022.3.jns22136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. Although inherently vascular lesions, the role of preoperative embolization prior to resection remains controversial. In this report, the authors describe an institutional series of patients with CBT successfully treated via resection following preoperative embolization and compare the results in this series to previously reported outcomes in the treatment of CBT. METHODS All CBTs resected between 2013 and 2019 at a single institution were retrospectively identified. All patients had undergone preoperative embolization performed by interventional neuroradiologists, and all had been operated on by a combined team of cerebrovascular neurosurgeons and otolaryngology-head and neck surgeons. The clinical, radiographic, endovascular, and perioperative data were collected. All procedural complications were recorded. RESULTS Among 22 patients with CBT, 63.6% were female and the median age was 55.5 years at the time of surgery. The most common presenting symptoms included a palpable neck mass (59.1%) and voice changes (22.7%). The average tumor volume was 15.01 ± 14.41 cm3. Most of the CBTs were Shamblin group 2 (95.5%). Blood was predominantly supplied from branches of the ascending pharyngeal artery, with an average of 2 vascular pedicles (range 1-4). Fifty percent of the tumors were embolized with more than one material: polyvinyl alcohol, 95.5%; Onyx, 50.0%; and N-butyl cyanoacrylate glue, 9.1%. The average reduction in tumor blush following embolization was 83% (range 40%-95%). No embolization procedural complications occurred. All resections were performed within 30 hours of embolization. The average operative time was 173.9 minutes, average estimated blood loss was 151.8 ml, and median length of hospital stay was 4 days. The rate of permanent postoperative complications was 0%; 2 patients experienced transient hoarseness, and 1 patient had medical complications related to alcohol withdrawal. CONCLUSIONS This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT at the authors' institution rests on a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and ear, nose, and throat-head and neck surgeons work together to optimally manage each patient with CBT.
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Affiliation(s)
- Alexander Ramos
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Joseph A Carnevale
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | | | - Gary Kocharian
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | | | | | - Justin Schwarz
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | | | - Jared Knopman
- 1Departments of Neurological Surgery
- 3Interventional Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Degollado-García J, Medina-Pizarro M, Cano-Velazquez G, Balcázar-Padrón JC, Gutierrez-Avila O, Nathal E. Microsurgical treatment of carotid body tumors using periadventitial dissection: Analysis of outcomes and prognostic factors in a neurological referral center. Surg Neurol Int 2022; 13:487. [DOI: 10.25259/sni_572_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Surgical resection for carotid body tumors (CBTs) is the gold standard of treatment and continues to be a challenging procedure, commonly associated with high vascular injury rates and neurological complications.
Methods:
It is a retrospective case series study between January 2002 and November 2020, with a mean follow-up of 29 months in a single nationwide referral center. Thirty-one patients diagnosed with a carotid body tumor and treated with microsurgical periadventitial resection were included in the study. Patients’ demographics, comorbidities, clinical, radiological factors, and tumor grade, evaluated by the Shamblin scale, were obtained. Statistical analysis was performed on all collected data.
Results:
In this study, we included 31 patients (32 tumors), 80% of the patients were female, and 20% were male, with a mean age of 53 years. One patient presented with bilateral lesions, while 17 tumors were located on the left side. The most frequent symptom was a painless, slow-growing neck mass in 74% of patients. Using the Shamblin classification, 13% of tumors were Grade I, 53% Grade II, and 34% Grade III. In the postoperative period, 3% of patients presented with permanent cranial nerve deficit, while none had vascular injuries or postoperative stroke. A tumor >5 cm increased the risk for nerve lesion by 11 times (OR 12.6, CI 95% 7.4-11.4, P < 0.001).
Conclusion:
Preoperative embolization followed by periadventitial resection by means of a microsurgical technique is a safe and effective approach to remove CBT, with 3% cranial nerve injury rate and no need for vascular sacrifice or reconstruction.
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Affiliation(s)
- Javier Degollado-García
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Mauricio Medina-Pizarro
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, United States,
| | - Gerardo Cano-Velazquez
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Juan C. Balcázar-Padrón
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
| | - Oscar Gutierrez-Avila
- Department of Neurological Surgery, Hospital Civil de Guadalajara. Guadalajara City, Mexico
| | - Edgar Nathal
- Department of Vascular Neurosurgery, Instuto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” - Mexico City, Mexico
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Clinical Characteristics and Surgical Outcomes of Carotid Body Tumors: Data from the Carotid Paraganglioma Cooperative International Registry (CAPACITY) Group. World J Surg 2022; 46:2507-2514. [DOI: 10.1007/s00268-022-06663-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 10/16/2022]
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Ma H, Wei M, Wang X, Bahetibieke H, Liu W, Wang X, Zeng J. Necessity of Intraoperative Level IIA Lymph Node Dissection in Patients with Carotid Body Tumors: A Retrospective Study of 126 Cases. ORL J Otorhinolaryngol Relat Spec 2021; 84:271-277. [PMID: 34610602 DOI: 10.1159/000519046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carotid body tumors (CBTs) are relatively uncommon neoplasms that rarely have malignant potential. However, malignant CBTs (MCBTs) are still associated with a poor prognosis and the treatment is still challenging clinically. Therefore, we evaluated the necessity of intraoperative level IIA lymph node dissection in patients with CBT. METHODS The clinical characteristics, intraoperative details, and pathological diagnosis of 126 CBT patients who had undergone surgery were retrospectively reviewed. The patients were divided into 2 groups according to whether level IIA lymph node dissection was performed. The prognosis was analyzed using Kaplan-Meier curves and Cox model multivariate survival analysis. RESULTS Among the 126 patients, 7 patients (10.3%) in the selective lymph node dissection (SLND) group (68 patients) were diagnosed with MCBTs with evidence of lymph node metastasis. Two patients (3.4%) in the lymph node nondissection (LNND) group (58 patients) were diagnosed with MCBTs later after the second operation because they could not be diagnosed as malignant initially because of the lack of lymph node pathology results although the pathology of the primary lesion showed features of malignancy. The SLND group had a significantly higher relapse-free survival rate than the LNND group (94.1% vs. 79.3%, p = 0.021). Patients with a confirmed diagnosis had a better prognosis than those with insufficient evidence of a malignancy due to the lack of lymph node information. Twenty-nine patients in the SLND group and 26 patients in the LNND group had postoperative nerve injuries, with no significant difference between the groups (p = 0.879). CONCLUSION Intraoperative dissection of level IIA lymph nodes around the tumor in CBT patients can help improve the diagnosis and prognosis of MCBTs without causing additional cranial nerve injury.
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Affiliation(s)
- Heng Ma
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China,
| | - Minghui Wei
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaolei Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Huerman Bahetibieke
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaoliang Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Jiaomei Zeng
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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Borghese O, Ferrer C, Pisani A, Camaioni A, Giudice R. Shamblin III Chemodectoma: The vascular surgeon's point of view. JOURNAL DE MEDECINE VASCULAIRE 2021; 46:209-214. [PMID: 34862014 DOI: 10.1016/j.jdmv.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Chemodectomas (CBTs) are the most frequently encountered tumours at the carotid bifurcation. Even if rare and commonly benign, their development close to the head and neck structures is often source of morbidity by compression and infiltration. Therefore, in order to avoid permanent neurologic or vascular complications these infrequent lesions need to be early removed. The total excision may be technically challenging and requires extensive expertise in surgical neck anatomy and a cooperative multidisciplinary approach. Almost a quarter of CBTs infiltrate carotid vessels so vascular expertise is pivotal in their resection. The present study aims to give an overview of vascular specificity and procedures required during surgical excision of such tumors to assist and guide treating physicians who encounter CBTs. This overview will particularly emphasize current therapeutic options: we discuss the referral criteria that should guide the decision about what type of preoperative care and surgical procedure should be offered to the affected patients. We also specify the epidemiologic data, screening recommendations and outcomes achieved with the different therapeutic approaches. The clinical, operative and follow-up data about a case of a Shamblin III carotid body tumour surgically removed by a multidisciplinary team at our Institution are also reported.
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Affiliation(s)
- Ottavia Borghese
- Departement of Surgery Pietro Valdoni, University Sapienza, Viale del Policlinico, 00100 Rome, Italy.
| | - Ciro Ferrer
- Department of Vascular and Endovascular Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angelo Pisani
- Departement of Cardiac Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Angelo Camaioni
- Department of Head and Neck Surgery, San Giovanni-Addolorata Hospital, Rome (RM), Italy
| | - Rocco Giudice
- Department of Vascular and Endovascular Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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Kameneva P, Kastriti ME, Adameyko I. Neuronal lineages derived from the nerve-associated Schwann cell precursors. Cell Mol Life Sci 2021; 78:513-529. [PMID: 32748156 PMCID: PMC7873084 DOI: 10.1007/s00018-020-03609-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/18/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022]
Abstract
For a long time, neurogenic placodes and migratory neural crest cells were considered the immediate sources building neurons of peripheral nervous system. Recently, a number of discoveries revealed the existence of another progenitor type-a nerve-associated multipotent Schwann cell precursors (SCPs) building enteric and parasympathetic neurons as well as neuroendocrine chromaffin cells. SCPs are neural crest-derived and are similar to the crest cells by their markers and differentiation potential. Such similarities, but also considerable differences, raise many questions pertaining to the medical side, fundamental developmental biology and evolution. Here, we discuss the genesis of Schwann cell precursors, their role in building peripheral neural structures and ponder on their role in the origin in congenial diseases associated with peripheral nervous systems.
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Affiliation(s)
- Polina Kameneva
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, 171 77, Sweden
| | - Maria Eleni Kastriti
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, 171 77, Sweden
- Department of Molecular Neurosciences, Center for Brain Research, Medical University Vienna, Vienna, 1090, Austria
| | - Igor Adameyko
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, 171 77, Sweden.
- Department of Molecular Neurosciences, Center for Brain Research, Medical University Vienna, Vienna, 1090, Austria.
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Kang J, Heo SH, Park YJ, Kim DI, Kim YW. Differential Diagnosis and Treatment Outcomes of Tumors at the Carotid Bifurcation. Vasc Specialist Int 2020; 36:128-135. [PMID: 32759464 PMCID: PMC7531300 DOI: 10.5758/vsi.200022] [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: 04/23/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose Primary tumor at the carotid bifurcation is uncommon, which includes paraganglioma, schwannoma, and lymphoma. Due to their rarity, characteristics of these tumors and problems related to their surgical treatment have not been well known. We tried to elucidate different clinical characteristics and surgical complications of these tumors. Materials and Methods We retrospectively reviewed 21 patients with carotid bifurcation tumor from the Vascular Surgery division of a Korean tertiary institution from 1995 to 2018. We investigated patients' demographics and clinical features, image characteristics, treatment details, and surgical outcomes. Results During the period from January 1995 to January 2018, we experienced surgical resections of 21 carotid bifurcation tumors which included 16 (76.2%) paragangliomas and 5 (23.8%) schwannomas. The most common clinical feature was a non-tender cervical mass. According to Shamblin classification, paragangliomas were classified into class II in 68.8% and class III in 25.0%. On the preoperative computed tomography images, all the paragangliomas showed characteristic splaying of the carotid bifurcation and hypervascularity of the tumors. On the contrary, all the schwannomas showed hypovascularity and splaying sign in 60%. Surgical complications related to cervical nerve injury developed in 50% and 60% of patients with Shamblin class III paraganglioma and schwannoma, respectively. During the mean follow-up period of 25 months (range, 1 to 163 months), distant metastases developed in 2 (12.5%) of paraganglioma patients. Conclusion Neurologic complications were more common after surgical resection of Shamblin class III paraganglioma and schwannoma. For patients with paraganglioma, postoperative periodic follow-up examination is advised to detect distant metastasis.
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Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Jhala K, Menias C, Hammer M. Paragangliomas Throughout the Body: Hereditary Syndromes and Imaging Features Including 3D Cinematic Rendering. Curr Probl Diagn Radiol 2020; 50:523-531. [PMID: 32980208 DOI: 10.1067/j.cpradiol.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022]
Abstract
Paragangliomas are highly vascular neuroendocrine tumors that arise from embryonic neural crest cells. They may either be hormonally active (sympathetic) or silent (parasympathetic). Approximately one-third are hereditary, and patients may develop multiple paragangliomas. Presurgical planning involves medical management as well as interventional and/or surgical techniques that must address vascular supply. Contrast-enhanced CT is the best initial anatomical study and shows the hypervascularity and feeding vessels. 3D cinematic rendering using multiplanar light sources can highlight spatial relationships of a mass to adjacent structures and help in surgical planning. This article will review the clinical presentation of paragangliomas, genetic syndromes, presurgical management, and tumor behavior and imaging appearance by location with a particular emphasis on 3D cinematic rendering.
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Affiliation(s)
- Khushboo Jhala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | | | - Mark Hammer
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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12
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Schwarze V, Marschner C, Negrao De Figueiredo G, Ingrisch M, Rübenthaler J, Clevert DA. Single-center study: dynamic contrast-enhanced ultrasound in the diagnostic assessment of carotid body tumors. Quant Imaging Med Surg 2020; 10:1739-1747. [PMID: 32879853 DOI: 10.21037/qims-19-920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Carotid body tumors (CBTs) depict the most common paraganglioma of the head and neck that can metastasize in up to 15% of cases. They develop either sporadically or hereditarily and may produce catecholamines ("functioning CBTs") resulting in associated symptoms like headache, palpitations or flush. Non-functioning CBTs usually present as slowly and often tender growing mass which may affect adjacent cranial nerves. CBTs can be visualized by ultrasound, CT, MRI or angiography. Pre-surgical interventional embolization, surgical resection and radiation therapy are therapeutical options. The aim of this retrospective single-center study is to assess the safe and real-time evaluation of CBTs by contrast-enhanced ultrasound (CEUS). Methods Ten patients with CBT were included in this study on whom CEUS was performed between 2007-2018 (mean age: 62 years). In 6/10 patients, results were confirmed by MRI, 4/12 patients underwent subsequent angiography. CEUS was performed and interpreted by a single consultant radiologist with experience since 2000 (EFSUMB level 3). VueBox® software was used for standardized perfusion quantification. Results CEUS allowed to detect all CBTs and visualize intratumoral microcirculation. Perfusion quantification was performed in 6/10 cases. CBTs showed significantly reduced peak-enhancement (PE), reduced wash-in perfusion index (WiPI) and significantly elevated time to peak (TTP) compared to common carotid arteries (CCA). Conclusions CEUS is a useful and safe tool for identifying CBTs and evaluating intratumoral microperfusion at high spatial and temporal resolutions in real-time. In addition to conventional ultrasound, CT, MRI and digital substraction angiography (DSA), CEUS may be implemented in the future diagnostic work-up and follow-up of CBT patients.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | | | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany
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Wernick BD, Furlough CL, Patel U, Samant S, Hoel AW, Rodriguez HE, Tomita TT, Eskandari MK. Contemporary management of carotid body tumors in a Midwestern academic center. Surgery 2020; 169:700-704. [PMID: 32868107 DOI: 10.1016/j.surg.2020.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Carotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection. METHODS A single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX). RESULTS Among 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21-79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1-9 days). At a mean follow-up of 12 months (range 1-63 months), there has been no recurrence. CONCLUSION Although carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.
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Affiliation(s)
- Brian Daniel Wernick
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Courtney L Furlough
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Urjeet Patel
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sandeep Samant
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tadaki T Tomita
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Siddiqui E, Shah A, Para A, Baredes S, Park RCW. Risk assessment of hypertension in carotid body surgeries: A NSQIP analysis. Laryngoscope 2019; 130:2008-2012. [DOI: 10.1002/lary.28373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/26/2019] [Accepted: 09/23/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Emaad Siddiqui
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Aakash Shah
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Ashok Para
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
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Snezhkina AV, Lukyanova EN, Fedorova MS, Kalinin DV, Melnikova NV, Stepanov OA, Kiseleva MV, Kaprin AD, Pudova EA, Kudryavtseva AV. Novel Genes Associated with the Development of Carotid Paragangliomas. Mol Biol 2019. [DOI: 10.1134/s0026893319040137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Abstract
The complex anatomy of the carotid space within a small confined area is unique to the head and neck and allows for a vast array of pathology. This paper will review the anatomy of the carotid space from the skull base to the thorax, defining its borders at multiple levels, as well as its contents. The paper will also describe the myriad of mass lesions and vascular pathologies that may occur within the carotid space. The discussion will include anatomic considerations in differential diagnoses, imaging features, and lesion characteristics across multiple imaging modalities including CT, MRI, ultrasound, and conventional angiography. Entities discussed include paragangliomas, nerve sheath tumors, meningioma, fibromuscular dysplasia, carotidynia, thrombus, dissection, pseudoaneurysm, and pathology of the deep cervical chain lymph nodes. Understanding the complex and unique anatomy of the carotid space, as well as the nuances of navigating a broad differential, will empower the reader to make an accurate diagnosis.
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Affiliation(s)
- Harris U Chengazi
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA.
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
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17
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Bakshi J, Goyal A, Vir D, Panda N. Multiple paragangliomas involving carotid body and vagal region. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_8_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Ng DW, Yam CI, Wong LT, Koh DL. An anaesthesia perspective on carotid body tumour (CBT) excision: A twenty-year case series at the Singapore General Hospital. J Perioper Pract 2018; 27:228-233. [PMID: 29328847 DOI: 10.1177/175045891702701005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
Abstract
Carotid body tumours (CBT) are extremely rare neoplasms that arise from chemoreceptor cells at the bifurcation of the carotid artery. This rarity poses a challenge for the anaesthetist when dealing with surgeries for the removal of CBT. Reports of associated perioperative morbidity range from twenty to forty percent. This paper reviews the perioperative anaesthetic management of CBT patients and challenges in our institution's 20 year experience on 13 surgical CBT resections.
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19
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Jansen TTG, Marres HAM, Kaanders JHAM, Kunst HPM. A meta-analysis on the surgical management of paraganglioma of the carotid body per Shamblin class. Clin Otolaryngol 2018; 43:1104-1116. [PMID: 29656606 DOI: 10.1111/coa.13116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the risk associated with different types of surgery for carotid body paraganglioma of different Shamblin class. A meta-analysis was conducted to evaluate per tumour class, the local control, cranial nerve damage and complication rates of different techniques using internal carotid artery (ICA) and external carotid artery (ECA) ligation, clamping or bypassing, as well as the craniocaudal vs caudocranial techniques. DESIGN A meta-analysis is conducted after a systematic search in PubMed and the Cochrane library, in accordance with the PRISMA guidelines. MAIN OUTCOME MEASURES Local control, cranial nerve damage, complications, function recovery. RESULTS Out of 3565 articles, 27 were selected. The overall quality of evidence of studies was low. Cranial nerve damage (3%, 17% and 39%) and complication rates (0%, 1% and 10%) were significantly related to Shamblin class (class 1, 2 and 3, respectively, P < .01). For class 3 tumours, an increased risk of complications was found associated with routine ICA manipulation/reconstruction (RR 3.12 with a 95% CI of 1.29-7.59), as well as a trend towards enhanced risk of routine ECA ligation (RR 3.48 with a 95% CI of 0.88-13.81). CONCLUSIONS For class 1 and 2 tumours, surgery seems a viable treatment option. For class 3 tumours, morbidity in terms of cranial nerve deficit and complications is considerable; particularly, the use of ICA manipulation/reconstruction and potentially ECA ligation seem to be accompanied by high stroke incidence.
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Affiliation(s)
- T T G Jansen
- Department of Otolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H A M Marres
- Department of Otolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H P M Kunst
- Department of Otolaryngology and Head & Neck Surgery, Radboudumc Skull Base Centre, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Elmore SA, Aeffner F, Bangari DS, Crabbs TA, Fossey S, Gad SC, Haschek WM, Hoane JS, Janardhan K, Kovi RC, Pearse G, Wancket LM, Quist EM. Proceedings of the 2017 National Toxicology Program Satellite Symposium. Toxicol Pathol 2017; 45:799-833. [PMID: 29113559 PMCID: PMC5743204 DOI: 10.1177/0192623317733924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The 2017 annual National Toxicology Program Satellite Symposium, entitled "Pathology Potpourri," was held in Montreal, Quebec, Canada at the Society of Toxicologic Pathology's 36th annual meeting. The goal of this symposium was to present and discuss challenging diagnostic pathology and/or nomenclature issues. This article presents summaries of the speakers' talks along with select images that were used by the audience for voting and discussion. Various lesions and other topics covered during the symposium included renal papillary degeneration in perinatally exposed animals, an atriocaval mesothelioma, an unusual presentation of an alveolar-bronchiolar carcinoma, a paraganglioma of the organ of Zuckerkandl (also called an extra-adrenal pheochromocytoma), the use of human muscle samples to illustrate the challenges of manual scoring of fluorescent staining, intertubular spermatocytic seminomas, medical device pathology assessment and discussion of the approval process, collagen-induced arthritis, incisor denticles, ameloblast degeneration and poorly mineralized enamel matrix, connective tissue paragangliomas, microcystin-LR toxicity, perivascular mast cells in the forebrain thalamus unrelated to treatment, and 2 cases that provided a review of the International Harmonization of Nomenclature and Diagnostic Criteria (INHAND) bone nomenclature and recommended application of the terminology in routine nonclinical toxicity studies.
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Affiliation(s)
- Susan A. Elmore
- National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | | | - Torrie A. Crabbs
- Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina
| | | | | | - Wanda M. Haschek
- University of Illinois, Department of Pathobiology, Urbana, Illinois
| | | | | | - Ramesh C. Kovi
- Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina
| | - Gail Pearse
- GlaxoSmithKline, Ware, Hertfordshire, United Kingdom
| | | | - Erin M. Quist
- Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina
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21
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Hua Q, Xu Z, Jiang Y. Diagnosis and surgical treatment of carotid body tumor: A retrospective analysis of 58 patients. Oncol Lett 2017; 14:3628-3632. [PMID: 28927123 DOI: 10.3892/ol.2017.6582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to illustrate the diagnosis and treatment of carotid body tumor (CBT) based on our experience of previous patients. A total of 58 patients (62 lesions) with CBT who received surgery between October 2003 and October 2013 were included. In total, 17 lesions were categorized into Shamblin grade I, 33 were grade II, and 12 were grade III. Surgical resection of CBT was performed for 52 lesions, resection of CBT and the external carotid artery was performed for 9 lesions, and resection of CBT and the internal carotid artery was performed for 1 lesion. No hemiplegia was observed. Hoarseness and bucking were observed in 2 patients of Shamblin grade III, and were eliminated 1 month subsequent to the administration of hormone therapy and a nerve-nurturing strategy. No relapse or mortality was observed during the follow-up. In conclusion, surgical resection of CBT is recommended following diagnosis. The evaluation of imaging features and cerebral collateral circulation is important for treatment.
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Affiliation(s)
- Qingquan Hua
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Zhen Xu
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yang Jiang
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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22
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Diagnostic, Surgical, and Postoperative Challenges of Neuroendocrine Tumors of the Neck: Clinical Experience and Literature Review. Ann Vasc Surg 2017; 45:92-97. [PMID: 28688875 DOI: 10.1016/j.avsg.2017.06.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neuroendocrine tumors of the neck are rare swellings, which constitute about 0.03% of all tumors. Most are sporadically arising paragangliomas. Over 50% arise from the carotid bodies and pose difficulties in diagnosis and surgical management, which may result in disabling complications. OBJECTIVE To determine the diagnostic, surgical, and postoperative challenges, and how to overcome them, in the management of neuroendocrine tumors of the neck. STUDY DESIGN Descriptive case series. METHODS A retrospective analysis of 19 patients who presented to our surgery clinics between 2010 and 2015 with neck swelling and suspicion of neurogenic tumors were included in the study. All patients received preoperative evaluation with Doppler studies and neck computed tomography scan, with the finding of suspicion of neurogenic tumor. Preoperative tissue diagnosis was not attempted as this usually required excisional biopsy. All tumors were surgically excised. Data regarding mean tumor size, neurovascular invasion, postoperative complications, and histopathological findings were recorded and statistically analyzed. RESULTS Nineteen patients (7 male) with median age of 45 years were included. Mean size of the tumor was 7.5 cm (range: 4.0-11.8 cm). Six of the tumors were right sided and 13 left sided. Clinical findings often were nonspecific and mimicked other conditions. Operative challenges were encountered in 11 (57.9%) patients, who had tumors of more than 5 cm. Vascular invasion was found in 2 (10.5%) patients, but bleeding requiring preoperative transfusion was not required in any patient. Neurological complications occurred in 11 (57.8%) patients; 3 had transit hypoglossal nerve palsy, with full recovery; 2 had complete nerve palsy, with reasonable rehabilitation without further surgical intervention; and 5 developed neurological deficits (hoarseness, dysphagia, or Horner's syndrome) but recovered and compensated well without further operation. Two patients who had vascular invasion required vascular reconstruction. Histopathology in 14 (73.7%) cases was carotid body tumor and 5 were Schwannomas (1 vagal and 4 sympathetic chain). All 4 patients with Schwannomas of cervical sympathetic chain developed Horner's syndrome; 2 of them have compensated well with reasonable recovery; 2 have had tarsorrhaphy for cosmetic reasons. The patient with vagal Schwannoma developed hoarseness and swallowing difficulties, which resolved without intervention. No malignancy was encountered in this series, and there was no mortality. CONCLUSIONS Neuroendocrine tumors of the neck present diagnostic challenges because of nonspecific clinical findings mimicking other conditions. Preoperative tissue diagnosis is mostly unsuccessful, and exact diagnosis requires excisional biopsy. Surgical excision, which is the main treatment, often has associated technical difficulties and unavoidable complications requiring further intervention.
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23
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Classic signs in head and neck imaging. Clin Radiol 2016; 71:1211-1222. [DOI: 10.1016/j.crad.2016.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 07/09/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
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24
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Kumari K, Jain D, Kumar R, Mohan A, Kumar R. Metastatic carotid body paraganglioma of lungs and lymph nodes: Unsuspected diagnosis on EBUS-TBNA. Diagn Cytopathol 2016; 45:327-332. [DOI: 10.1002/dc.23650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Kalpana Kumari
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - Deepali Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - Rohit Kumar
- Department of Pulmonary medicine and sleep disorders; All India Institute of Medical Sciences; New Delhi India
| | - Anant Mohan
- Department of Pulmonary medicine and sleep disorders; All India Institute of Medical Sciences; New Delhi India
| | - Rakesh Kumar
- Department of Nuclear medicine; All India Institute of Medical Sciences; New Delhi India
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25
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Jin ZQ, He W, Wu DF, Lin MY, Jiang HT. Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2106-2113. [PMID: 27316787 DOI: 10.1016/j.ultrasmedbio.2016.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Abstract
A carotid body tumor (CBT) is a rare, non-chromaffin paraganglioma, and its diagnosis mainly depends on imaging modalities. The aim of this study was to investigate the ability of color Doppler ultrasound (CDU) in the diagnosis and assessment of CBT based on computed tomography (CT). We retrospectively reviewed the CDU and CT features of 49 consecutive CBTs and 23 schwannomas from 67 patients and compared these findings with surgical resection specimens. The mean size of CBT lesions on ultrasound scans and CT angiography (CTA) was 3.24 cm ± 0.82 cm (range, 1.6-5.2 cm) and 3.84 cm ± 1.08 cm (range, 1.8-6.8 cm), respectively, which had statistically significant difference (t = 9.815, p = 0.000). The vascularity of CBT lesions was richer than that of schwannoma lesions (p < 0.05). Intra-lesional vascularities feeding CBT mostly arose from the external carotid artery and had spectrum characteristics including low velocity and resistance. Peak systolic velocity (PSV) and resistance index (RI) of the vasa vasorum were 39.8 cm/s ± 19.8 cm/s and 0.54 ± 0.06, respectively. There was the correlation between CTA and CDU in identifying Shamblin type I CBT lesions, while CTA technique was superior for CDU, identifying Shamblin type II and III CBT lesions. Accuracy, specificity and sensitivity of CDU in diagnosing CBTs were 87.5% (63 of 72), 82.6% (19 of 23) and 89.8% (44 of 49), respectively. Both accuracy and sensitivity of CTA in diagnosing CBTs were 100%. CDU can be useful for assessment of Shamblin's type and intra-lesional blood flow of CBTs before its metastases, while CT imaging can reveal the relationship between lesions and adjacent arteries, as well as the involvement of the skull base. CDU combined with CT imaging can be used as an optimal detection modality for the assessment and management of CBT.
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Affiliation(s)
- Zhan-Qiang Jin
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Dong-Fang Wu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mei-Ying Lin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
| | - Hua-Tang Jiang
- Department of Radiology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
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Abstract
Although carotid body tumor (CBT) is a rare neoplasm, it should always be considered in differential diagnosis of lateral neck masses. We shared the 10 years of CBT experience in our clinic and started a discussion on CBT with literature support. A total of 21 patients with CBT diagnosis in Fırat University Hospital, Otorhinolaryngology Clinic, participated in the study. Patients were evaluated based on demographical data and particularities of the tumor. Participant patients were 19 women and 2 men, and their ages were between 21 and 79 (mean age 54.06 ± 12.48). The most frequent reason for the patients to apply to the hospital was painless swelling in the neck (76.2%). Tumor was located in the right side of the neck in 10 patients (47.6%), and in the left side of the neck in 11 (52.4%). Twenty patients (95.2%) had undergone computerized tomography angiography. Surgical treatment was applied to 19 patients (90.5%) and the tumor was totally excised. According to Shamblin classification, 15 of the tumors of these patients were class II (78.9%) and 4 were class III (21.1%). In 1 patient (5.3%), postoperative contusion infection that recovered after medical treatment was observed; in 2 patients (10.5%), n. vagus injury was observed because of tumor's pervasion of n. vagus; and in 1 of these patients vocal cord paralysis was developed and this patient was later taken into thyroplasty surgery. Two patients (10.5%) suffered n. hypoglossus injury, 1 of these recovered within 3 months postoperative and the other developed n. hypoglossus palsy. The size and extension of the tumor should be determined by preoperative imaging for the correct planning of surgical procedure. It should be taken into consideration that despite advanced surgical techniques, the rate of postoperative cranial nerve damage is still high.
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27
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Mesquita N, Silva RS, Ribeiro JHA, Batista LC, Bringhentti EMS, de Souza BBB, Cabral LCDM. Tumor de corpo carotídeo (paraganglioma): relato de dois casos submetidos a tratamento cirúrgico. J Vasc Bras 2016; 15:158-164. [PMID: 29930583 PMCID: PMC5829712 DOI: 10.1590/1677-5449.007315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O tumor de corpo carotídeo é uma neoplasia rara, geralmente benigna, que acomete, sobretudo, indivíduos entre a quarta e a quinta décadas de vida. Manifesta-se pela presença de massa cervical consistente localizada abaixo do ângulo da mandíbula, pulsátil e comumente indolor. Pode evoluir para dor local, disfagia, soluços, rouquidão e síndrome do corpo carotídeo hipersensível. Este artigo relata os casos de duas pacientes diagnosticadas com essa neoplasia e submetidas ao tratamento cirúrgico. A primeira foi submetida a uma ressecção em bloco do tumor, enquanto a segunda, com estadiamento mais precoce, foi tratada com uma ressecção subadventicial da lesão.
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Affiliation(s)
- Nelson Mesquita
- Faculdade Evangélica do Paraná - FEPAR, Curitiba, PR, Brasil
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28
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Dixon JL, Atkins MD, Bohannon WT, Buckley CJ, Lairmore TC. Surgical management of carotid body tumors: a 15-year single institution experience employing an interdisciplinary approach. Proc AMIA Symp 2016; 29:16-20. [PMID: 26722157 PMCID: PMC4677842 DOI: 10.1080/08998280.2016.11929343] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Cervical paragangliomas are rare neoplasms that arise from extraadrenal paraganglia in close association with the cranial nerves and extracranial arterial system of the head and neck, and therefore surgical extirpation can be challenging. A retrospective study was conducted of all patients undergoing surgical excision of a cervical paraganglioma between 2000 and 2015. The demographic characteristics, clinical features, surgical approach, and outcomes were reviewed. A total of 20 cervical paragangliomas were excised in 17 patients. There were 14 female and 3 male patients with a mean age of 56.6 ± 17.0 at the time of operation. Twelve patients had unilateral tumors and 5 patients had bilateral tumors. Familial involvement was confirmed by history or direct genetic analysis in 8 (47%) of the 17 patients. There were no malignant paragangliomas, and only 3 patients had tumors that were determined to be functional. Tumor size ranged from 1.3 to 6.0 cm. Two patients required combined arterial resection as part of complete excision of the tumor. There were no permanent operative cranial nerve injuries, no recurrences, minimal morbidity, and no mortality. In conclusion, optimal management of cervical paragangliomas should include a thorough preoperative evaluation, accurate definition of the surgical anatomy, and exclusion of synchronous paragangliomas. A combined therapeutic approach by a multidisciplinary team including surgeons and interventional radiologists provides safe and effective management of cervical paragangliomas with very low morbidity and excellent outcomes.
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Affiliation(s)
- Jennifer L Dixon
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Marvin D Atkins
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - William T Bohannon
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Clifford J Buckley
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
| | - Terry C Lairmore
- Baylor Scott & White Healthcare and Texas A&M University Health Science Center College of Medicine, Temple, Texas
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29
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Budincevic H, Piršic A, Bohm T, Trajbar T, Ivkošic A, Pavlovic T, Bielen I, Soldo-Butkovic S. Carotid Body Tumor as a Cause of Stroke. Intern Med 2016; 55:295-8. [PMID: 26831027 DOI: 10.2169/internalmedicine.55.5350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We herein report a case of a 78-year-old woman who was admitted to our hospital due to a stroke with left-sided hemiparesis. Ultrasound of the carotid arteries showed a carotid body tumor on the bifurcation of the right common carotid artery, which was subsequently confirmed by a further neuroradiological investigation. Magnetic resonance imaging of the head confirmed an acute ischemic lesion located in the right periventricular region. The carotid body tumor (CBT) was surgically removed and confirmed on histopathology. Our case reveals the role of carotid ultrasound in the diagnosis of a CBT, which may be a potential cause of stroke.
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Affiliation(s)
- Hrvoje Budincevic
- Stroke and Intensive Care Unit, Department of Neurology, Sveti Duh University Hospital, Croatia
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30
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Shakir HJ, Diletti SM, Hart AM, Meyers JE, Dumont TM, Siddiqui AH. Carotid body tumor imitator: An interesting case of Castleman's disease. Surg Neurol Int 2015; 6:181. [PMID: 26677415 PMCID: PMC4681130 DOI: 10.4103/2152-7806.171239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/18/2015] [Indexed: 12/11/2022] Open
Abstract
Background: There are very few reports in the literature of Castleman's disease affecting the carotid artery and a single previous report of a case of Castleman's disease of the neck originally mistaken as a carotid body tumor. Case Description: We describe a rare case of Castleman's disease, manifesting with classic radiographic hallmarks of a carotid body tumor. The postoperative pathologic examination identified the resected mass as Castleman's lymphadenopathy. The management of this particular case is discussed, and the findings are highlighted. Conclusions: We present a unique case of a tumor initially and incorrectly diagnosed as a carotid body tumor. However, after comprehensive treatment with endovascular and surgical modalities and subsequent pathologic examination, the diagnosis of this rare entity was made.
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Affiliation(s)
- Hakeem J Shakir
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York, USA ; Department of Neurosurgery, Kaleida Health, Gates Vascular Institute, Buffalo General Medical Center, University at Buffalo, Buffalo, New York, USA
| | - Sara M Diletti
- Department of Neurosurgery, Kaleida Health, Gates Vascular Institute, Buffalo General Medical Center, University at Buffalo, Buffalo, New York, USA
| | - Alexandra M Hart
- Department of Pathology, Kaleida Health, Buffalo General Medical Center, State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Joshua E Meyers
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York, USA ; Department of Neurosurgery, Kaleida Health, Gates Vascular Institute, Buffalo General Medical Center, University at Buffalo, Buffalo, New York, USA
| | - Travis M Dumont
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York, USA ; Department of Neurosurgery, Kaleida Health, Gates Vascular Institute, Buffalo General Medical Center, University at Buffalo, Buffalo, New York, USA ; Department of Neurosurgery, Department of Medical Imaging, Division of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York, USA ; Department of Neurosurgery, Kaleida Health, Gates Vascular Institute, Buffalo General Medical Center, University at Buffalo, Buffalo, New York, USA ; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York, USA ; Toshiba Stroke and Vascular Research Center, State University of New York, University at Buffalo, Buffalo, New York, USA ; Jacobs Institute, Buffalo, New York, USA
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Hinojosa CA, Ortiz-Lopez LJ, Anaya-Ayala JE, Orozco-Sevilla V, Nunez-Salgado AE. Comparison of retrocarotid and caudocranial dissection techniques for the surgical treatment of carotid body tumors. J Vasc Surg 2015; 62:958-64. [DOI: 10.1016/j.jvs.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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Paschoal FM, Albuquerque Paschoal EH, Rogério RM, Teixeira MJ, Bor-Seng-Shu E. Neck paraganglioma: head rotation maneuver on transcranial Doppler ultrasonography. Clin Neurol Neurosurg 2015; 137:5-7. [PMID: 26115050 DOI: 10.1016/j.clineuro.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/04/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Fernando Mendes Paschoal
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil.
| | - Eric Homero Albuquerque Paschoal
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil
| | | | - Manoel Jacobsen Teixeira
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil
| | - Edson Bor-Seng-Shu
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil
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Karigar SL, Kunakeri S, Shetti AN. Anesthetic management of carotid body tumor excision: A case report and brief review. Anesth Essays Res 2015; 8:259-62. [PMID: 25886240 PMCID: PMC4173617 DOI: 10.4103/0259-1162.134528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Carotid body tumor (CBT) is a rare tumor, which arises at bifurcation of carotid artery from chemoreceptor cells. These cells sense the partial pressure of oxygen and carbon dioxide from the blood. Hence, carotid body plays an important role in the control of ventilation during hypoxia, hypercapnia, and acidosis. The tumor arising from these cells is benign and has tendency to turn out malignant. This tumor is found in persons who live at high altitudes. Removal of tumor poses several anesthetic challenges and perioperative morbidity or mortality. We report successful anesthetic management of CBT excision.
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Affiliation(s)
- Shivanand L Karigar
- Department of Anesthesiology, BLDE University and Research Centre, Bijapur, Karnataka, India
| | - Sangamesh Kunakeri
- Department of Anesthesiology, Bidar Medical Sciences, Bidar, Karnataka, India
| | - Akshaya N Shetti
- Department of Anesthesiology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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Gulavani N, Rodrigues G, Prabhu R, Kamath G, Rai L, Rao L. Non-functioning Aortocaval Paraganglioma Masquerading as Celiac Lymphnodal Metastasis. Eurasian J Med 2015; 46:53-6. [PMID: 25610296 DOI: 10.5152/eajm.2014.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/11/2013] [Indexed: 11/22/2022] Open
Abstract
An extra-adrenal paraganglioma is a rare tumour derived from chromaffin cells of sympathetic ganglia. This report documents a rare case of a non-functional aortocaval paraganglioma in a 24-year-old woman with persistent abdominal pain. Computed tomography revealed a solid mass, measuring 2.5x3cms, localized between the celiac trunk and superior mesenteric artery in aortocaval location along with right ovarian cystic mass. A clinical diagnosis of malignant ovarian tumour with celiac nodal metastasis was made. Excision and pathological analysis of both revealed an aortocaval extra-adrenal paraganglioma and benign ovarian cyst. On serial follow-up the patient was in a good health, asymptomatic and without evidence of tumour recurrence. This case emphasizes the necessity of including extra-adrenal paraganglioma in the differential diagnosis and management of retroperitoneal tumours, despite its rarity.
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Affiliation(s)
- Nikhil Gulavani
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India
| | - Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India
| | - Raghunath Prabhu
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India
| | - Ganesh Kamath
- Department of Cardiothoracic and Vascular Surgery, Kasturba Medical College, Manipal University, Manipal, India
| | - Lavanya Rai
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, India
| | - Lakshmi Rao
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, India
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Gilbo P, Morris CG, Amdur RJ, Werning JW, Dziegielewski PT, Kirwan J, Mendenhall WM. Radiotherapy for benign head and neck paragangliomas: a 45-year experience. Cancer 2014; 120:3738-43. [PMID: 25060724 DOI: 10.1002/cncr.28923] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Paragangliomas of the head and neck are rare, slow-growing, generally benign tumors of neuroendocrine cells associated with the peripheral nervous system that commonly involve the carotid body, jugular bulb, vagal ganglia, and temporal bone. Treatment options include surgery, radiotherapy (RT), stereotactic radiosurgery (SRS), and observation. This article briefly reviews our 45-year institutional experience treating this neoplasm with RT. METHODS From January 1968 through March 2011, 131 patients with 156 benign paragangliomas of the temporal bone, carotid body, jugular bulb, or glomus vagale were treated with RT at a median dose of 45 Gy in 25 fractions. The mean and median follow-up times were 11.5 years and 8.7 years, respectively. RESULTS Five tumors (3.2%) recurred locally after RT, all within 10 years of treatment. The overall local control rates at 5 and 10 years were 99% and 96%, respectively. The cause-specific survival rates at 5 and 10 years were 98% and 97%, respectively. The distant-metastasis free survival rates at 5 and 10 years were 99% and 99%, respectively. The overall survival rates at 5 and 10 years were 91% and 72%, respectively. There were no severe complications. CONCLUSION RT for benign head and neck paragangliomas is a safe and efficacious treatment associated with minimal morbidity. Surgery is reserved for patients in good health whose risk of associated morbidity is low. SRS may be suitable for patients with skull base tumors <3 cm where RT is logistically unsuitable. Observation is a reasonable option for asymptomatic patients with a limited life expectancy.
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Affiliation(s)
- Philip Gilbo
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
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36
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Ma Y, Huang D, Liu L, Xiang M, Oghagbon E, Zhai S. Surgical treatment of carotid body tumour: a report of 39 cases and a new classification of carotid body tumour: Our Experience. Clin Otolaryngol 2014; 39:254-7. [PMID: 24920404 DOI: 10.1111/coa.12267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Ma
- Department of Otolaryngology, Head and Neck Surgery; Chinese PLA General Hospital; Beijing China
- Department of Otolaryngology, Head and Neck Surgery; Beijing Friendship Hospital; Capital Medical University; Xicheng District Beijing China
| | - D. Huang
- Department of Otolaryngology, Head and Neck Surgery; Chinese PLA General Hospital; Beijing China
| | - L. Liu
- Department of Otolaryngology, Head and Neck Surgery; Beijing Friendship Hospital; Capital Medical University; Xicheng District Beijing China
| | - M. Xiang
- School of Science; University of Greenwich; Chatham Maritime Kent UK
| | - E.K. Oghagbon
- Department of Chemical Pathology; Faculty of Basic & Allied Medical Sciences; College of Heath Sciences; Benue State University; Makurdi Nigeria
| | - S. Zhai
- Department of Otolaryngology, Head and Neck Surgery; Chinese PLA General Hospital; Beijing China
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37
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Serra R, Grande R, Gallelli L, Rende P, Scarcello E, Buffone G, Caliò FG, Gasbarro V, Amato B, de Franciscis S. Carotid body paragangliomas and matrix metalloproteinases. Ann Vasc Surg 2014; 28:1665-70. [PMID: 24704048 DOI: 10.1016/j.avsg.2014.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The carotid body tumors (CBTs) are relatively rare neoplasms and may present into benign or life threatening malignant forms. Matrix metalloproteinases (MMPs) are often involved in vascular and cancer diseases. Objective of this study is to study the relationship between CBTs and MMPs. METHODS We performed a multicenter study on 14 patients with CBTs. All tumors were resected. For each patient, we evaluated the MMPs' levels in both plasma (enzyme-linked immunosorbent assay [ELISA] test) and tissue samples (Western blot analysis). These MMPs' plasma levels were compared with the MMPs' plasma levels of healthy patients. RESULTS Eleven patients had benign CBTs, whereas 3 patients had malignant CBTs. ELISA findings revealed significant higher levels (P < 0.01) of MMP-1, -2, -3, -8, and -9 in patients with paraganglioma with respect to healthy patients. Patients with malignant CBTs showed significantly higher levels (P < 0.01) of MMP-1, -2, and -3 compared with patients with benign CBTs. CONCLUSIONS Because this is an exploratory study, the experience on this casuistry showed that MMPs' evaluation may help clinicians and surgeons to formulate a more rapid and clear diagnosis on CBTs' behavior. However, other studies on a large group of patients may be useful to validate these observations.
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Affiliation(s)
- Raffaele Serra
- Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Raffaele Grande
- Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pierandrea Rende
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Gianluca Buffone
- Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Vincenzo Gasbarro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Bruno Amato
- Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University of Naples "Federico II", Naples, Italy
| | - Stefano de Franciscis
- Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
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38
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Utilidad de la gammagrafía de receptores de somatostatina en la detección de recurrencias y seguimiento de paragangliomas carotídeos. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2013.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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39
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Paragangliomas of the carotid body: current management protocols and review of literature. Indian J Surg Oncol 2013; 4:305-12. [PMID: 24426745 DOI: 10.1007/s13193-013-0249-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 05/31/2013] [Indexed: 01/26/2023] Open
Abstract
Paraganglioma is a rare neoplasm arising from carotid body usually benign and constitute 0.5 % of all total body tumors. They constitute 60-70 % of head and neck paraganglioma and resemble other paragangliomas of the body like glomus jugulare, glomus tympanicum, and pheochromocytoma. This is a retrospective analysis of the medical records of carotid body paraganglioma cases. Nine patients operated during the study period and the follow up traced were included in the study. Seven females and 2 males were analysed. Six had tumor on the left side and 3 had on the right side. All the cases surgical excision was done by a tranverse incision as 2 patients had Shamblin I, 5 patients had Shamblin II, and 1 patients Shamblin IIIa. All the Shamblin I had tumor away from the carotids and were easily dissected without vessel damage, a sub adventitial tumor excision was performed in all the 5 cases of Shamblin II, 1 case of Shamblin IIIa was dissected with difficulty without sacrificing or vessel reconstruction. Paraganglioma of the carotid body should be considered as a differential diagnosis for painless lateral neck masses. Larger tumors need a multidisciplinary team of head and neck with vascular surgeons for better results.
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40
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Clinical characteristics and strategy for treatment of functional carotid body tumours. Int J Oral Maxillofac Surg 2013; 42:436-9. [DOI: 10.1016/j.ijom.2012.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 06/19/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022]
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Lieberson RE, Adler JR, Soltys SG, Choi C, Gibbs IC, Chang SD. Stereotactic radiosurgery as the primary treatment for new and recurrent paragangliomas: is open surgical resection still the treatment of choice? World Neurosurg 2012; 77:745-61. [PMID: 22818172 DOI: 10.1016/j.wneu.2011.03.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 01/16/2011] [Accepted: 03/23/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Paragangliomas (PGs) or glomus tumors are rare, and publications comparing treatment alternatives are few. We sought to analyze our experience with stereotactic radiosurgery (SRS), review the literature, and develop treatment guidelines. METHODS We retrospectively examined the outcomes of 41 PGs in 36 patients treated with SRS at Stanford. Our data from medical records, telephone interviews, and imaging studies were combined with previously reported SRS data and compared to results following other treatments. RESULTS With a median clinical follow-up of 4.8 years (3.9 years radiographic), local control was 100%. Complications included increase in preexistent vertigo in one patient and transient cranial neuropathies in two patients. Published surgical series describe a lower local control rate as well as more frequent and severe complications. Published radiation therapy (RT) series document a slightly lower local control rate than SRS, but SRS can be delivered more quickly and conveniently. Open surgery and other combinations of treatments appear to be required for several subpopulations of PG patients. CONCLUSIONS We feel that SRS should be the primary treatment for most new and recurrent PGs. Even some very large PGs are appropriate for SRS. RT remains an appropriate option in some centers, especially those where SRS is not available. PGs occurring in the youngest patients, catecholamine secreting PGs, and PGs causing rapidly progressing neurologic deficits may be more appropriate for open resection. Metastatic PGs may benefit from combinations of chemotherapy and SRS or RT. Treatment guidelines are proposed.
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Affiliation(s)
- Robert E Lieberson
- Department of Neurosurgery, Stanford Hospital and Clinics, Stanford University, Stanford, California, USA.
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42
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Zhang TH, Jiang WL, Li YL, Li B, Yamakawa T. Perioperative Approach in the Surgical Management of Carotid Body Tumors. Ann Vasc Surg 2012; 26:775-82. [DOI: 10.1016/j.avsg.2012.01.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 12/26/2011] [Accepted: 01/24/2012] [Indexed: 11/30/2022]
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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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O'Neill S, O'Donnell M, Harkin D, Loughrey M, Lee B, Blair P. A 22-year Northern Irish experience of carotid body tumours. THE ULSTER MEDICAL JOURNAL 2011; 80:133-40. [PMID: 23526121 PMCID: PMC3605524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2011] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Carotid body tumours (CBTs) are rare vascular neoplasms originating in paraganglionic cells of the carotid bifurcation. The aim of this study was to review all patients diagnosed with CBTs in Northern Ireland. METHODS A retrospective review was performed of all patients who had CBTs treated at our institutions between 1987 and 2009. Patient demographics, clinical symptomatology, investigative modality, therapeutic intervention, pathological analysis and long-term outcomes were assessed. RESULTS Twenty-nine patients were identified with 33 CBTs and three glomus intravagale tumours (GITs). Six patients had bilateral CBTs (21%), one of whom had a synchronous GIT. Twenty-six patients underwent a total of 30 operative procedures for the resection of 28 CBTs and 3 GITs. Conventional operative treatment included subadventitial tumour excision. A vascular shunt facilitated arterial reconstruction following the removal of seven (23%) tumours and on six of these occasions (19%) continuity was restored with an interposition vein graft. For access the external carotid artery was ligated during the removal of four tumours (13%). Two tumours were considered malignant. No peri-operative mortalities were recorded. Immediate complications included peri-operative stroke secondary to an occluded vein graft (n=1), requirement of tracheostomy (n=2), emergency haematoma drainage (n=2) and transient cranial nerve damage (n=8). Late complications included pseudoaneurysm of vein graft with subsequent stoke (n=1), permanent cranial nerve damage (n=9), Horner's syndrome (n=1) and an asymptomatic vein graft occlusion (n=1). One patient had tumour recurrence two years post-operatively and died due to pulmonary metastases. Two other patients died of unrelated causes. All other patients remain well with no evidence of tumour recurrence at mean followup of 1801 days (range 159-9208 days). CONCLUSION Our long-term experience is comparable with other reported case series where surgical intervention conferred a long-term survival advantage despite associated cranial nerve co-morbidities.
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Affiliation(s)
- Stephen O'Neill
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Northern Ireland
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Wiegand S, Kureck I, Chapot R, Sesterhenn AM, Bien S, Werner JA. Early side effects after embolization of a carotid body tumor using Onyx. J Vasc Surg 2010; 52:742-5. [DOI: 10.1016/j.jvs.2010.04.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/30/2010] [Accepted: 04/11/2010] [Indexed: 11/25/2022]
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Hurtado-Lopez LM, Fink-Josephi G, Ramos-Méndez L, Dena-Espinoza E. Nonresectable carotid body tumor: hybrid surgical procedure to achieve complete and safe resection. Head Neck 2009; 30:1646-9. [PMID: 18302274 DOI: 10.1002/hed.20808] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Carotid body tumors of Shamblin class III without free internal carotid, between the tumor and skull base, are considered nonresectable. The objective of this work is to describe a surgical technique that combines traditional and endovascular strategies to achieve a safe surgical resection of the carotid body tumor of this class. METHODS AND RESULTS A female patient with a nonresectable carotid body tumor underwent placement of an endoprosthesis going from the common carotid artery to the internal carotid beyond the skull base (to secure cerebral circulation) excluding the external carotid artery. Forty-five days later, the tumor was resected without vascular or cranial nerves injury, and bleeding amounted to 50 cm(3). At 6 months, the patient is tumor free and asymptomatic. CONCLUSION This is the first known reported case that has been successfully resolved by combining endovascular and traditional strategies. The endoprosthesis maintained cerebral circulation, which otherwise would have been impossible; besides, the vascular supply from the external carotid artery was excluded leading to a decrease in tumor size and a recovery of the sub-adventitial dissection plane, allowing for a successful and safe tumor resection.
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Hinerman RW, Amdur RJ, Morris CG, Kirwan J, Mendenhall WM. Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience. Head Neck 2009; 30:1431-8. [PMID: 18704974 DOI: 10.1002/hed.20885] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND An evaluation of the treatment results for 104 patients with 121 paragangliomas of the temporal bone, carotid body, and/or glomus vagale who were treated with radiation therapy (RT) at the University of Florida between 1968 and 2004. METHODS Eighty-nine paragangliomas (86%) were treated with conventional megavoltage techniques, 15 (14%) patients with stereotactic fractionated radiation therapy, 6 (6%) patients with stereotactic radiosurgery (SRS), and 11 (11%) patients with intensity-modulated radiation therapy (IMRT). RESULTS There were 6 local recurrences. One recurrence was salvaged with additional RT. The actuarial local control and cause-specific survival rates at 10 years were 94% and 95%. The overall local control rate for all 121 lesions was 95%; the ultimate local control rate was 96%. The incidence of treatment-related complications was low. CONCLUSION Fractionated RT offers a high probability of tumor control with minimal risks for patients with paragangliomas of the temporal bone and neck.
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Affiliation(s)
- Russell W Hinerman
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
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49
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Abstract
OBJECTIVE To evaluate a modified technique for carotid body tumor (CBT) resection. BACKGROUND Resection of CBT can lead to substantial postoperative morbidity because of a rich vascularization and close connection to neurovascular structures. The impact of a modified surgical technique on postoperative outcome was evaluated and compared with a historical group and the literature. METHODS Medical records of patients who underwent CBT surgery at Leiden University Medical Center between 1963 and 2005 were retrospectively reviewed. Before 1992, a standard approach was conducted. After 1992, most tumors were resected using an alternative technique, working in a craniocaudal fashion from skull base to carotid bifurcation. Data were reported as details of the pre, intra-, and postoperative periods. RESULTS A total of 111 CBT resections (69 standard, 42 craniocaudal) were performed in 94 patients (44 male/50 female, mean age 41). The standard group consisted of 39 Shamblin I (56%), 22 II (32%), and 8 III (12%) tumors. The craniocaudally approached CBT included 12 Shamblin I (29%), 13 II (31%), and 17 III (40%) tumors. The mean blood loss was 901 mL (standard operations) versus 281 mL (craniocaudal approach, P < 0.0005). Persistent cranial nerve damage was encountered after 26 (23%) of 111 operations; 21 after the standard operations (30% within this group, including 3 preexistent nonresolved cranial nerve deficits); and 5 (12%, including 2 due to additional vagal body resections) after the craniocaudal operations (P = 0.025). CONCLUSIONS The craniocaudal dissection technique of a CBT can be applied with little blood loss, thereby reducing the risk of postoperative morbidity.
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Corless M. A Case Report on a Carotid Body Tumor Coexisting With an Occlusion of the Internal Carotid Artery. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2007. [DOI: 10.1177/8756479307299537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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