Carotid body paraganglioma: a case report.

A highly vascular glomus tumor that develops from the paraganglion cells of the carotid body is called a carotid body tumor (CBT), also known as a chemodectoma or carotid body paraganglioma (CBP). It is situated near the carotid bifurcation, where the external and internal carotid arteries splay out characteristically. We present a case of a 30-year-old woman who had a slightly tender, slightly pulsatile, and slightly ballotable swelling over the lateral aspect of the neck on the right side. The surgical resection of the tumor was done based on the diagnosis made on clinical-radiological investigations as a carotid body tumor further confirmed by a histopathological study. We also provide a summary of the research on carotid body tumors clinical and imaging manifestations, assessment, and therapy.

Shamblin III Chemodectoma: The vascular surgeon's point of view.

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.

Propuesta de clasificación tomográfica preoperatoria para el tumor del cuerpo carotideo / Proposal for a preoperative tomographic classification for carotid body tumor

OBJETIVO: proponer una clasificación preoperatoria a los pacientes con tumor de cuerpo Carotídeo y relacionarlos con complicaciones postoperatorias. MATERIAL Y MÉTODOS: todos los pacientes operados con diagnóstico de tumor del cuerpo Carotídeo entre el 2005 al 2014 en el Hospital Obrero N° 1 de la Caja Nacional de Salud en La Paz - Bolivia RESULTADOS: se analizaron y operaron 115 pacientes con un promedio de edad de 52 años (DE±11,725 y una moda de 57 años) de los cuales el 109 (94,80%) correspondieron al género femenino con una razón de 18:1. Todos los pacientes eran originarios y residentes de ciudades ubicadas a más de 2500 m.s.n.m. El promedio de evolución fue de 3 años (DE±2,189), y solo 7 pacientes (6,1%) presentan hábito tabáquico. 83 pacientes (72,2%) de los TCC se localizan en el lado izquierdo En las manifestaciones clínicas, todos los pacientes presentan el tumor localizado en el ángulo mandibular, por delante del musculo esternocleidomastoideo, describiéndose un crecimiento paulatino y permanente en 72 sujetos (62,6%), cefalea en 45 (39,1%), presencia de latido en 30 sujetos (26,1%), disfagia en 9 (7,9%), mareos en 16 (13,9%) y disfonía en 6 (5,2%). Entre los signos más evidentes de TCC, se describe el signo de Fontaine en 114 sujetos (99,2%), adenomegalia en 20 (17,4%) y otros menos frecuentes como soplo, abombamiento parafaringeo y compromiso de pares craneales. Todos los pacientes fueron clasificados en ambos sistemas (Shamblin y la nuestra llamada de los Andes). Se describen 39 pacientes (33,2%) con complicaciones postoperatorias, Grado I: 1 paciente sin complicaciones; Grado II: de 58 sujetos, 4 (3,5%) presentaban parálisis temporal del Hipogloso; en el Grado III: de los 41 sujetos, 24 (20,8%) presentaron ligadura de la arteria carótida externa, parálisis del hipogloso y glosofaringeo, lesión de recurrente y del laríngeo superior. En el grupo IV, de los 15 sujetos operados, 11 presentaron complicaciones (9,6% del total y 73% del grupo) entre las cuales están ligadura de la arteria carótida externa, lesión del hipogloso y un paciente con AVC y hemiparesia. Se describe una reoperación (0,86%) y ninguna mortalidad. CONCLUSIÓN: proponer una clasificación preoperatoria que tenga la posibilidad de asociarse a complicaciones y pronóstico.

OBJECTIVE: to propose a preoperative classification of patients with Carotid Body Tumor and relate them to postoperative complications. MATERIAL AND METHODS: all patients operated with a diagnosis of Carotid Body Tumor between 2005 and 2014 at the Obrero Hospital No. 1 of the National Health Fund in La Paz - Bolivia RESULTS: 115 patients with an average age of 52 years (SD±11.725 and a mode of 57 years) were analyzed and operated on, of which 109 (94.80%) corresponded to the female gender with a ratio of 18: 1. All the patients were from and residents of cities located more than 2,500 meters above sea level. The mean evolution was 3 years (SD±2.189), and only 7 patients (6.1%) had a smoking habit. 83 patients (72.2%) of CBTs are located on the left side In the clinical manifestations, all patients present the tumor located in the mandibular angle, in front of the sternocleidomastoid muscle, describing a gradual and permanent growth in 72 subjects (62.6%), headache in 45 (39.1%), presence of heartbeat in 30 subjects (26.1%), dysphagia in 9 (7.9%), dizziness in 16 (13.9%) and dysphonia in 6 (5.2%). Among the most obvious signs of CBT, the Fontaine sign is described in 114 subjects (99.2%), adenomegaly in 20 (17.4%) and other less frequent signs such as murmur, parapharyngeal bulging and cranial nerve involvement. All patients were classified in both systems (Shamblin and ours called from the Andes). 39 patients (33.2%) with postoperative complications were described, grade I: 1 patient without complications; Grade II: of 58 subjects, 4 (3.5%) had temporary hypoglossal paralysis; in Grade III: of the 41 subjects, 24 (20.8%) presented external carotid artery ligation, hypoglossal and glossopharyngeal paralysis, recurrent lesion and superior larynx. In group IV, of the 15 operated subjects, 11 presented complications (9.6% of the total and 73% of the group), among which are external carotid artery ligation, hypoglossal injury and one patient with stroke and hemiparesis. A reoperation (0.86%) and no mortality are described. CONCLUSION: propose a preoperative classification that has the possibility of being associated with complications and prognosis.

Carotid body tumor: a case report and literature review.

The carotid body is the largest collection of paraganglia in the head and neck and is found on the medial aspect of the carotid bifurcation bilaterally. Carotid body tumors are rare neoplasms arising from the chemoreceptor cells of the carotid bulb. We report a case of carotid body tumor in a 42-year-old female, who presented with painless, pulsatile, gradually progressive lateral neck swelling. The diagnosis is suspected on the basis of history, clinical and radiological examination findings and a successful surgical excision of the tumor is performed. Histopathological examination confirms the diagnosis of carotid body tumor. We also present brief literature about carotid body tumors in terms of its clinical and imaging presentation, evaluation, and management.

Role of radiosurgery in the management of glomus tumors.

BACKGROUND: Glomus tumors are benign slow-growing hypervascular neoplasms. The role of radiosurgery for the treatment of these tumors has increased. The purpose of this study was to show our experience with glomus tumors and to analyze different prognostic factors. METHODS: Data from 39 adult patients were retrospectively analyzed. All of them underwent head frame stereotactic radiosurgery with linear accelerator (LINAC). Tumor and symptomatic control were calculated using the Kaplan-Meier method. Bivariate statistical analyses were performed to examine different prognostic factors. RESULTS: The median follow-up was 71 months. The radiological local and symptomatic control was achieved in 37 patients (94.8%) and 29 patients (74.3%), respectively. Toxicity was detected in 4 patients (10%). In the bivariate analysis, dose coverage and maximum dose were associated with tumor control with an odds ratio (OR) of 5.29 (p = .041) and 2.67 (p = .056), respectively. CONCLUSION: Stereotactic radiosurgery is a safe and efficient treatment for glomus tumors that is associated with high probability of radiological and symptomatic control and low incidence of morbidity. © 2015 Wiley Periodicals, Inc. Head Neck 38: E798-E804, 2016.

Paragangliomas cervicales. Resultados actuales comparados con los de la serie histórica / Cervical paragangliomas. Comparison of current results with historical series

Antecedentes: los paragangliomas cervicales son tumores poco frecuentes, que reciben diferentes denominaciones según su ubicación. Los que asientan en la bifurcación carotdea son llamados ca-rotdeos; en el oído medio, tmpánicos; en el bulbo yugular, yugulares y en el nervio vagal, vagales. Lugar de aplicación: hospital público de atención terciaria de tumores. Población: veintséis pacientes, 22 de ellos operados. La edad media fue 48,6 años, el 77% del sexo femenino. Método: revisión de historias clínicas e informes de anatomía patológica. Resultados: doce eran izquierdos, 11 derechos, 2 bilaterales y 1 múltple. Se llegó al diagnóstico por la semiología, por angiorresonancia y por tomografa computarizada. Fueron divididos según la clasificación de Shamblin en grado 1-2 en 16 y grado 3 en 10. La extensión de la cirugía demandó en todos la resección del tumor que implicó en 2 la reparación vascular, en 2 la resección de los pares craneales XI y XII y en los 4 restantes por ser asintomáticos solo la observación. La morbilidad fue del 22,7%, las secuelas del 31,8% y la mortalidad del 4,5% distnta a la presentada en la serie histórica de 44,4%, 55,5% y 5,4%, respectvamente. Conclusiones: 1) Los tumores del cuerpo carotdeo son infrecuentes, benignos en su mayoría y de crecimiento lento. 2) Los recursos diagnósticos más utlizados fueron: el ecodoppler, la tomografa computarizada con contraste y la angiorresonancia, con resultados positvos en el 100% de los casos, a diferencia de la serie histórica donde se utlizó la angiografa con éxito en el diagnóstico en el 70%. 3) Los pacientes con tumores I, II y III sintomáticos de la clasificación de Shamblin son quirúrgicos con un porcentaje de secuelas del 31,8 % a diferencia de la serie histórica del 55,5 %. 4) En los tumores tpo III asintomáticos la selección de los pacientes debe ser cuidadosamente considerada para recomendar una cirugía agresiva y con alta morbilidad. Esta conclusión difere de la presentada en la serie histórica, donde todos los pacientes fueron intervenidos quirúrgicamente.

Background: cervical paragangliomas are very rare tumours and receive diferent names according to the site of origin. Carotd for those localized in the carotd bifurcaton, tympanic for those in the middle ear, yugular for those in the yugular bulb and vagal for those in the vagal nerve. Setng: tertary care oncologic public hospita. Populaton: 26 patents, 22 of them surgically treated. Mean age was 48.6 years, 77% female. Methods: review of clinical records and pathologic reports. Results: twelve were at the lef side, 11 at the right, 2 bilateral and 1 multple. Diagnosis was done by semiology, magnetic resonance and computed tomography. The tumors were classifed according to Shamblin classificaton in 1, 2 grades in 16 patents and 3 in 10. Surgery included tumor resecton with vascular graf in 2, XI and XII craneal nerve also in 2, while 4 patents remained in observaton because they were asymptomatic. Morbidity was 22.7%, sequels 31.8% and mortality 4.5%, diferent to the historic series with 44.4%, 55.5% and 5.4% respectvely. Conclusions: tumors of carotd body are infrequent, benign and of slow growth. Diagnostic techniques frequently used were ecodopler, CT scan and MRI, with positve results in about 100% of cases. It was diferent to historic series in which angiographic studies had positve results in only 70% of them. Symptomatic Shamblin 1, 2 and 3 were surgically treated with 31.8% of sequels, diferent to historic sample with 55.5%, but in asymptomatic grade 3, careful selecton of patents must be taken into ac-count for avoiding an aggressive surgery with high morbidity. This conclusion is diferent of the historic series in which all patents were surgically treated.

Clinical response and tumor control based on long-term follow-up and patient-reported outcomes in patients with chemodectomas of the skull base and head and neck region treated with highly conformal radiation therapy.

BACKGROUND: The purpose of this study was to evaluate long-term outcome after radiation therapy (RT) for skull base or head-and-neck chemodectomas. METHODS: We treated 39 patients with chemodectomas with RT. Patients were treated with either single dose stereotactic radiosurgery, fractionated stereotactic radiotherapy, or intensity modulated radiotherapy (IMRT), depending on the size and anatomy of the lesion. At primary diagnosis, 16 patients were treated with surgical resection (41%), 4 with interventional embolization (10%), and 19 with primary RT (49%). Single doses of 18 Gy/80% isodose were applied. For fractionated treatments delivered as primary RT, a median total dose of 57.6 Gy was delivered. Five patients were treated with re-irradiation, of which 4 were treated with fractionated regimens; total dose was 28.8 Gy, 30 Gy, 40 Gy, and 56 Gy in 1.8 to 2 Gy single fractions. RESULTS: Clinical symptoms improved in 18 patients (46%), remained unchanged in 10 patients (26%), and worsening of sequelae was observed in only 1 patient, which was associated with tumor progression. Actuarial local control was 97% at 10 years. Overall survival was 89% at 5 years and 87% at 10 years. Deaths were not disease-related except in 3 patients with tumor progression. No secondary malignancies were observed. CONCLUSION: RT has been established as a treatment alternative for patients with glomus tumors. Long-term local control is very high, with good clinical response to treatment.