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1.
Angiol Sosud Khir ; 26(4): 155-159, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332318

RESUMO

Described herein is a clinical case report regarding successful surgical treatment of a female patient presenting with a large paraganglioma of the right common carotid artery. On admission, the woman had complained of a mass in her neck, having significantly enlarged within the previous 6 months, with the appearance of dysphagia and moderate pain syndrome. The findings of multislice computed angiography and ultrasonographic duplex angioscanning of the brachiocephalic arteries helped to verify the location, size, and topography of the tumour. Taking into account the diagnosed secondary foci in the lungs, it was decided to first perform embolization of the artery supplying the tumour, which was followed by biopsy of tissue of the neoplasm. After histological verification and ruling out malignancy, successful radical resection of the paraganglioma was performed.


Assuntos
Tumor do Corpo Carotídeo , Embolização Terapêutica , Paraganglioma , Tronco Braquiocefálico , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Tumor do Corpo Carotídeo/diagnóstico , Tumor do Corpo Carotídeo/cirurgia , Feminino , Humanos , Paraganglioma/diagnóstico , Paraganglioma/cirurgia
2.
Ann Vasc Surg ; 67: 200-207, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32234392

RESUMO

BACKGROUND: Carotid body tumors (CBTs) are rare tumors in the neck. Surgical resection is the gold standard of treatment. Surgical resection may be complicated by bleeding. Preoperative embolization has recently been introduced for the treatment to reduce the quantity of blood loss; however, the outcomes of this procedure are still under debate. In this article, we have presented the outcomes of patients who underwent surgical resection for CBT without undergoing preoperative embolization in our institution. METHODS: This retrospective study reviewed 67 tumor resection cases who underwent surgical resection for CBTs without undergoing preoperative embolization. Tumor classification was performed as per the Shamblin classification. The demographic, clinical characteristics, and the operative information about the patients were retrieved from the patient records. The obtained data were analyzed with descriptive statistics. RESULTS: The study included 12 male and 55 female patients. The mean age was 51.95 ± 16.59 years. Of the surgically resected tumors; 11 (16.4%) were Shamblin type I, 30 (44.8%) were Shamblin type II, and 26 (38.8%) were Shamblin type III. The mean duration of operation was 109.10 ± 32.36 min. The volume of intraoperative blood loss in the Shamblin type I, type II, and type III groups were 98.64 ± 23.46 cc, 215.33 ± 75.74 cc, and 351.73 ± 62.51 cc, respectively, and they were significantly different among the groups (P < 0.001). The volume of postoperative blood loss in the Shamblin type I, type II, and type III groups were 34.09 ± 10.44 cc, 53.00 ± 20.02 cc, and 62.50 ± 25.11 cc, respectively, and they were significantly different among the groups (P = 0.003). Cranial nerve injury developed in 10 (15.0%) patients. Postoperative stroke developed in 2 (3%) patients. No mortality or persistent nerve injury was observed in association with the injury in the patients during the 1-year follow-up period. CONCLUSIONS: CBTs can be surgically resected safely and effectively without a need for preoperative embolization.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Tumor do Corpo Carotídeo/cirurgia , Embolização Terapêutica , Hemorragia Pós-Operatória/prevenção & controle , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
3.
Medicine (Baltimore) ; 99(3): e18824, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011493

RESUMO

This study aims to investigate the clinical characteristics and outcomes of carotid body tumors in Chinese patients in the last decade. A systematic search was conducted without limits and included studies published between January 2006 and December 2016 according to PubMed, the Chinese Science Citation Database, the China Science Periodical Database and the China National Knowledge Infrastructure. Relevant synonyms for the search terms "paraganglioma" and "carotid body tumor" were applied, and the clinical data were evaluated and analyzed. There were 1810 cases of CBTs reported in the last decade, of which females accounted for 60.22%, and the mean age was 40.60 years, with most cases being sporadic (98.51%). Surgical resection was performed in 1791 cases: vessel repair occurred in 38.88% of the cases, carotid ligation occurred in 1.42% of the cases, and 1.05% of the patients refused treatment. Some patients underwent selective embolization, and the results showed that embolization could decrease procedure time and blood loss (P < .01). Stroke and death occurred in 1.95% and 0.39% of patients, respectively. Malignant CBTs accounted for 4.30% of cases, and the metastatic sites involved were local metastasis (46.88%), lung (31.25%), bone (21.88%), liver (12.50%), and brain (9.38%). The overall survival rate was 98.87% 36 months after the procedure, and the survival rate of metastatic cases was 56.25% 6 months after recurrence; however, only 21.88% of metastatic cases received radiotherapy. The CBTs of Chinese patients showed some clinical features that were different from those of Western patients.


Assuntos
Tumor do Corpo Carotídeo/etnologia , Tumor do Corpo Carotídeo/cirurgia , China/epidemiologia , Humanos
4.
Intern Med ; 59(9): 1167-1171, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32023584

RESUMO

A 53-year-old woman was admitted to a hospital for gradual left-ear hearing loss over 2 years. Head computed tomography revealed a 2-cm mass along the left jugular bulb and another at the right carotid bulb. The right tumor was resected; the pathological diagnosis was carotid body paraganglioma. Mutations of succinate dehydrogenase (SDH) were suspected, but SDHB staining remained in the tumor. Genetic testing identified a known SDHB mutation (L157X). The patient had head and neck paraganglioma with an SDHB mutation (L157X) more typical of an SDHD mutation. SDHB immunohistochemistry is useful for detecting SDHx mutations, but careful interpretation is needed.


Assuntos
Tumor do Corpo Carotídeo/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Succinato Desidrogenase/genética , Tumor do Corpo Carotídeo/complicações , Tumor do Corpo Carotídeo/genética , Tumor do Corpo Carotídeo/cirurgia , Diagnóstico Diferencial , Feminino , Mutação em Linhagem Germinativa , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/genética , Neoplasias de Cabeça e Pescoço/cirurgia , Perda Auditiva/etiologia , Humanos , Pessoa de Meia-Idade
5.
Ann Vasc Surg ; 64: 163-168, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31634604

RESUMO

BACKGROUND: Carotid body tumors (CBTs) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used; however, controversy exists over whether a benefit is associated. Proponents of embolization argue it minimizes blood loss and complications. Critics argue cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes after CBT resection. METHODS: Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database for 5 states during the years 2006-2013. Patients were divided into 2 groups: carotid body tumor resection alone (CBTR) and carotid body embolization prior to tumor resection (CBETR). Descriptive statistics were calculated using arithmetic means with standard deviations for continuous and proportions for categorical variables. Patients were propensity score matched on the basis of sex, age, race, insurance, and comorbidity before analysis. Risk-adjusted odds of mortality, stroke, nerve injury, blood loss, and length of stay (LOS) were calculated using mixed-effects regression models with fixed effects for age, race, sex, and comorbidities. RESULTS: A total of 547 patients were identified. Of these, 472 underwent CBTR and 75 underwent CBETR. Mean age was 54.7 ± 16 years. Mean number of days between embolization and resection was 0.65 ± 0.72, (range 0-3) days. When compared to CBTR, there were no significant differences in mortality for CBETR (1.35 vs. 0% P = 0.316), cranial nerve injury (2.7 vs. 0% P = 0.48), and blood loss (2.7 vs. 6.8% P = 0.245). After risk adjustment, CBETR increased the odds of prolonged LOS (OR: 5.3; CI 2.1-13.3). CONCLUSIONS: CBT resection is a relatively rare procedure. The utility of preoperative tumor embolization has been questioned. This study demonstrates no benefit of preoperative tumor embolization.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Embolização Terapêutica , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Bases de Dados Factuais , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Cuidados Pré-Operatórios/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversos
6.
Ann Vasc Surg ; 63: 325-331, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31626927

RESUMO

BACKGROUND: Carotid body tumor (CBT) is the most common head and neck paragangliomas. Surgical resection is the golden standard management for CBT. While preoperative embolization is still controversial, long-term outcomes and perioperative results are still deficient. We, here, presented the outcomes of surgical treatment for CBT without preoperative embolization at our institution. METHODS: In this retrospective study, we collected data from 101 patients who received surgical treatment for CBTs without preoperative embolization from 2011 to 2016. In addition, we attempted to conduct 2 years of follow-up under the guidance of both neurologist and vascular surgeon. Patients' demographics, clinical characteristics, complications, and follow-up results were all analyzed with descriptive statistics. RESULTS: Complete resection of the CBT was achieved in 101 cases (100%). Postoperative adverse events (AEs) mostly observed during hospitalization were as follows: tongue bias (I: 4, 36.4%; II: 8, 19.5%; III: 13, 26.5%), hoarseness (I: 1, 9.1%; II: 4, 9.8%; III: 7, 14.3%), dysphagia (I: 0; II: 2, 4.9%; III: 7, 14.3%), and hematoma (I: 0; II: 0; III: 1, 2.0%). No other serious AEs were observed. The total incidence of AEs in type I patients was 5 (45.5%), 14 (34.1%) in type II, and 28 (57.1%) in type III, and the type III group has significantly higher than the other two groups. At the end of 2 years of follow-up, there were no AEs in type I patients. The number of patients with AEs in type III was greater than that in type II, although there was no significant difference. Based on our findings, 3 most commonly injured cranial nerves (CNs) after surgical resection of CBT were CN XII (hypoglossal nerve, 21.9%), CN X (vagus nerve, 20.3%), and recurrent laryngeal nerve (18.8%). CONCLUSIONS: Surgical management without preoperative embolization for CBT patients is a safe and effective therapeutic approach.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto Jovem
7.
J Cardiovasc Surg (Torino) ; 61(4): 459-466, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31599140

RESUMO

BACKGROUND: The aim of this study is to report our results with carotid body tumor (CBT) surgical management. METHODS: Between 2010 and 2018, 100 CBTs (mean age: 48.0 years, range 21-80 years old) were treated in our center. The patients were classified in 3 groups according to the size: group I (<3 cm), group II (3 to 5 cm) and group III (>5 cm). RESULTS: Surgical resection was performed in 88 patients and conservative treatment in 2 cases. Nine patients were treated for bilateral involvement and one of them was also treated again for a relapse. Postoperatively, cranial nerve injury (CNI) was significantly higher in group II [3 (8.3%) vs. 16 (31.4%) vs. 2 (15.4%); P=0.030] with no statistical differences between the CN involved. At univariate analysis for CNI, CBT group (P=0.030), maximum diameter (P=0.046), patients presenting with dysphonia (P=0.035) and dysphagia (P=0.007) and patients suffering from any intraoperative complication (P=0.047) were statistically significant. At multivariate analysis the only significant variable was CBT group II (P=0.016). For blood loss, CBT group III (P<0.001), Shamblin class III (P<0.001), Pulmonary disease (P=0.034) and surgery time (P<0.001) were statistically significant. The follow-up of 79 patients (87.8%) showed a 100% overall survival at median follow-up of 37.7 months (range 2-84.7 months) with freedom from local recurrence of 97.8% (77/79). CONCLUSIONS: Surgical resection remains the gold standard to obtain complete recovery, although tumor size is to be considered a risk factor for CNI because large CBTs remain at high risk for CNIs.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Tumor do Corpo Carotídeo/mortalidade , Tumor do Corpo Carotídeo/terapia , Tratamento Conservador , Meios de Contraste , Embolização Terapêutica , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Radioterapia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Procedimentos Cirúrgicos Vasculares
8.
Laryngoscope ; 130(8): 2008-2012, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31774559

RESUMO

OBJECTIVES: Carotid body tumors (CBT) are rare paragangliomas of the carotid body at the carotid bifurcation. The purpose of this study was to determine the effect of hypertension on outcomes in carotid body tumor surgery. STUDY DESIGN: A retrospective database review. METHODS: Data on carotid body resections performed from 2005 to 2014 were drawn from the American College of Surgeons' National Surgical Quality Improvement database. Two groups were created based on the presence of preoperative hypertension. These groups were analyzed for demographics, comorbidities, and postoperative complications using bivariate and multivariate methods. RESULTS: Of the 452 patients included in the analysis, 49.3% had hypertension. Those with hypertension were significantly more likely to have additional comorbidities, which were controlled for by multivariate analysis to focus on hypertension. These hypertensive patients also had significantly longer hospital stays. Multivariate analysis showed that patients with hypertension undergoing carotid body resections had increased risk for overall medical complications but did not have increased risk for postoperative surgical complications or specific medical complications CONCLUSION: This statistically robust study revealed that hypertension does not independently increase a patient's risk for specific postoperative surgical complications following a carotid body tumor resection. However, hypertension increases the risk for postoperative medical complications and longer hospital stays. It is notable that almost half of all CBT patients have hypertension, and these hypertensives patients are significantly more likely to carry additional comorbid conditions that may have an adverse effect on outcomes including overall medical complications. LEVEL OF EVIDENCE: NA Laryngoscope, 130: 2008-2012, 2020.


Assuntos
Tumor do Corpo Carotídeo/complicações , Tumor do Corpo Carotídeo/cirurgia , Hipertensão/complicações , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
10.
J Radiol Case Rep ; 13(8): 19-30, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31558967

RESUMO

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.


Assuntos
Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Adulto , Tumor do Corpo Carotídeo/cirurgia , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores
11.
World Neurosurg ; 132: 236-238, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479788

RESUMO

BACKGROUND: Jarcho-Levin syndrome (JLS) is a rare congenital disorder characterized by different clinical and radiologic findings. The disease was first reported by Jarcho and Levin in 1938, and it was described as the presence of various malformations or abnormal fusion in the thoracic vertebrae and ribs, short trunk, and respiratory distress. CASE DESCRIPTION: In our case, fusion at the thoracic and cervical vertebrae, butterfly vertebrae, and a crablike-shaped thorax was present. The patient had a short trunk, short stature, and long extremities. Moreover, he had a syndromic face and restrictive-type respiratory distress. There was a glomus tumor in the carotid space. In our literature review, we found that neural tube defects are frequently present in this syndrome. However, we could not identify any cases with affected neural crest cells. CONCLUSIONS: JLS may affect cells derived from the neural crest located between the neural tube and surface ectoderm. Therefore patients with JLS should be screened for other tumors located in this area.


Assuntos
Tumor do Corpo Carotídeo/complicações , Hérnia Diafragmática/complicações , Anormalidades Múltiplas/diagnóstico por imagem , Adulto , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/cirurgia , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Masculino
13.
World Neurosurg ; 129: 503-513.e2, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154101

RESUMO

BACKGROUND: Carotid body tumors (CBTs) are highly vascularized tumors which can render tumor resection surgery challenging. There is evidence suggesting that preoperative selective embolization can reduce blood loss during surgery and decrease the risk of perioperative complications; however, recent reports have questioned the benefits that preoperative embolization provides. The objective of this study is to investigate the impact of preoperative embolization on CBT surgical resection. METHODS: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies were identified through a search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials until March 2019. A random effects model meta-analysis was conducted, and the I2 statistic was used to assess for heterogeneity. RESULTS: Twenty-five studies comprising 1326 patients were included. Patients who received preoperative embolization had statistically significant lower intraoperative blood loss (weighted mean difference [WMD], -135.32; 95% confidence interval [CI], -224.58 to -46.06; I2 = 78.6%). Duration of the procedure was statistically significantly shorter in the preembolization group than the nonembolization group (WMD, -38.61; 95% CI, -65.61 to -11.62; I2 = 71.9%). There were no differences in the rates of cranial nerve (CN) injuries (odds ratio [OR], 1.13; 95% CI, 0.68-1.86; I2 = 12.9%), stroke (OR, 1.75; 95% CI, 0.70-4.36; I2 = 0%), transient ischemic attacks (TIAs) (OR, 0.55; 95% CI, 0.11-2.65; I2 = 0%), or length of stay (WMD, 0.32; 95% CI, -1.35 to 1.98; I2 = 96.4%) between the 2 groups. CONCLUSIONS: Patients who received embolization prior to CBT resection had statistically significant lower blood loss and shorter duration of operation. The rates of CN palsy, stroke, TIA, and length of stay were similar between patients who had preoperative embolization and those who did not.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Tumor do Corpo Carotídeo/cirurgia , Embolização Terapêutica/métodos , Cuidados Pré-Operatórios/métodos , Humanos
14.
Br J Neurosurg ; 33(5): 500-503, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31130023

RESUMO

Purpose: The carotid body functions as a chemoreceptor and receives richer blood supply, by weight, than any other organ in the body. We review the literature regarding the anatomy, histology, and function of the carotid body and the incidence, functionality, and clinical relevance of carotid body tumors and paragangliomas. These lesions are often nonfunctional but can be associated with catecholamine secretion. Most patients are asymptomatic or present initially with a cervical mass. As the tumors grow, they can impinge on nearby cranial nerves. Although there is some debate, the dominant clinical strategy is to surgically resect these tumors as early as possible. If they are resected early, the risk of postoperative neurovascular injury is minimized. Methods: Literature search was performed using the PubMed database with focus on articles including descriptions of the carotid body and associated tumors. Results: We reviewed recent literature that related to the anatomy of the carotid body while also including carotid pargangliomas and associated diagnosis with treatment interventions. Conclusion: As the carotid body serves as a vital modulator of cardiovascular and respiratory functions, illustrates the importance of identifying potential carotid paragangliomas due its ability to impede function of the carotid body. By understanding carotid paraganglioma's distinct etiologies while also understanding proper diagnosis of tumors allows for early detection and appropriate treatment options.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Corpo Carotídeo/cirurgia , Paraganglioma/cirurgia , Corpo Carotídeo/anatomia & histologia , Corpo Carotídeo/fisiopatologia , Tumor do Corpo Carotídeo/patologia , Tumor do Corpo Carotídeo/fisiopatologia , Humanos , Paraganglioma/patologia , Paraganglioma/fisiopatologia
15.
Head Neck ; 41(9): 3159-3167, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31116491

RESUMO

BACKGROUND: The aim of this study was to evaluate the efficacy of the procedure by analyzing the blood loss and duration of carotid body tumor (CBT) surgery following same-day preoperative embolization. METHODS: We reviewed the medical records of subjects retrospectively. Fifteen patients with 16 CBTs were enrolled in this study. Our same-day procedure comprises preoperative embolization of the feeding arteries in the morning followed by surgery within 3 hours after the embolization is completed. RESULTS: The mean operative time and the mean amount of blood loss were 138 minutes and 29.3 mL, respectively. The tumor volume after embolization was markedly reduced and the mean reduction rate was 50%. We found that 13 CBTs had more than three feeding arteries. Almost all the postoperative complications, mainly cranial nerve paralyzes, resolved within months after surgery. CONCLUSION: Our same-day procedure is a safer and superior alternative to traditional CBT surgery, having good outcomes.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Embolização Terapêutica , Adulto , Perda Sanguínea Cirúrgica , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Tumor do Corpo Carotídeo/terapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Tempo , Carga Tumoral
17.
Ear Nose Throat J ; 98(3): 165-168, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30922105

RESUMO

Primary giant cell tumor of soft tissue (GCT-ST) is a rare entity that is considered the soft tissue equivalent of giant cell tumor of bone. It most commonly arises in soft tissues of the trunk and extremities, with occurrence in the head and neck being extremely rare. We report a case of GCT-ST of the carotid body, the first report of a tumor of this kind arising from this site in the neck. Giant cell tumor of soft tissue is generally considered a benign tumor with low malignant potential; thus, surgical excision is usually curative. However, due to the location and invasive nature of this patient's tumor, complete excision was not possible. We discuss the implication of this for long-term management of this patient, as well as similarities and differences in clinical presentation, histology, and biological behavior between this case and previously reported cases of GCT-ST.


Assuntos
Tumor do Corpo Carotídeo , Tumores de Células Gigantes , Neoplasias de Cabeça e Pescoço , Esvaziamento Cervical/métodos , Neoplasias de Tecidos Moles , Adulto , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/patologia , Tumor do Corpo Carotídeo/cirurgia , Feminino , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
18.
Eur J Vasc Endovasc Surg ; 57(4): 477-486, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902606

RESUMO

OBJECTIVES: The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS: This is a systematic review and meta-analysis of 104 observational studies. RESULTS: Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS: This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Traumatismos dos Nervos Cranianos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Tumor do Corpo Carotídeo/mortalidade , Tumor do Corpo Carotídeo/terapia , Traumatismos dos Nervos Cranianos/etiologia , Embolização Terapêutica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/classificação , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/mortalidade
19.
Head Neck ; 41(5): 1379-1386, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771228

RESUMO

BACKGROUND: To review the Shamblin classification of carotid body paragangliomas (CBPs) and the role of intra-arterial stenting in their surgical management. METHODS: Retrospective case series of 20 patients with 28 CBPs that were surgically resected at our center. Intra-arterial stenting was performed in Shamblin II and II classes. RESULTS: The mean follow-up was 47.8 months. Five (17.9%) tumors were Shamblin class I, 15 (53.6%) were class II, and 8 (28.6%) were class III. Thirteen (68.4%) CBPs were associated with other paragangliomas. The internal carotid artery (ICA) was stented preoperatively in eight (28.6%) cases and occluded in four (14.3%) cases. The tumor extended to the jugular foramen in six cases (21.4%). Intraoperatively, there was an ICA injury in one case of Shamblin II CBP in the present era. CONCLUSIONS: The proposed classification enables the clinician to plan the management of the ICA and the right approach. Stenting of the ICA gives a chance for complete tumor removal with arterial preservation.


Assuntos
Angioplastia/métodos , Tumor do Corpo Carotídeo/classificação , Tumor do Corpo Carotídeo/cirurgia , Paraganglioma/classificação , Paraganglioma/cirurgia , Stents/estatística & dados numéricos , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Tumor do Corpo Carotídeo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Itália , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paraganglioma/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Ann Vasc Surg ; 57: 187-193, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684613

RESUMO

BACKGROUND: Carotid body tumors (CBTs) are rare neoplasms located in the carotid bifurcation. The majority of these tumors are unilateral; bilateral CBTs represent approximately 5% of all affected patients, and the recommended treatment is to surgically remove them in staged-planned surgeries. We describe the experience, outcomes, and the surgical management of bilateral CBTs in our institution. METHODS: A retrospective review of CBTs patients was completed; patient demographics, comorbidities, lesion location, anatomic characteristics, surgical techniques, complications, reinterventions, and other factors that may influence outcomes were evaluated. RESULTS: A total of 109 patients with CBTs were treated surgically; of these, 8 had bilateral CBTs (7%); the mean age was 56 years, and 7 (87%) were females. Thirteen surgical resections were performed, and in 2 of the cases, the pathology report was malignant (15%). Five were classified as Shamblin I (31%), 5 as Shamblin II (31%), and remaining 6 as Shamblin III (38%). The mean time between the first and second procedure was of 10.7 months. Complications included one case of neck hematoma requiring evacuation and postoperative neurologic complications occurred in three patients (one patient with facial and two with vocal cord palsies). None of the studied individuals had a family history of CBT, and all of them lived in altitude areas higher than 2000 meters above mean sea level (mamsl). The mean tumor size was 3.55 cm and 2.75 cm for right and left CBTs, respectively. CONCLUSIONS: A better understanding of the clinical characteristics of patients with bilateral CBTs may lead to a more standardized and optimal management with fewer complications and a better quality of life afterward.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/epidemiologia , Tumor do Corpo Carotídeo/patologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/efeitos adversos
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