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Piazza C, Lancini D, Tomasoni M, Zafereo M, Poorten VV, Hanna E, Mäkitie AA, Fernandez-Alvarez V, Kowalski LP, Chiesa-Estomba C, Ferlito A. Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature. Head Neck 2024; 46:672-687. [PMID: 38179805 DOI: 10.1002/hed.27624] [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: 11/04/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
Malignant carotid body tumors (MCBT) are rare and diagnosed after detection of nodal or distant metastases. This systematic review (SR) focuses on MCBT initially approached by surgery. Preferred Reporting Items for SR and Meta-Analysis (MA) guided the articles search from 2000 to 2023 on PubMed, Scopus, and Web of Science. Among 3548 papers, 132 (337 patients) were considered for SR; of these, 20 (158 patients) for MA. Malignancy rate was 7.3%, succinate dehydrogenase (SDH) mutation 17%, age at diagnosis between 4th and 6th decades, with a higher prevalence of females. MCBTs were mostly Shamblin III, with nodal and distant metastasis in 79.7% and 44.7%, respectively. Malignancy should be suspected if CBT >4 cm, Shamblin III, painful or otherwise symptomatic, at the extremes of age, bilateral, with multifocal disease, and SDHx mutations. Levels II-III clearance should be performed to exclude nodal metastases and adjuvant treatments considered on a case-by-case basis.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Ehab Hanna
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Veronica Fernandez-Alvarez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Torrecardenas, Almeria, Spain
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology - Head and Neck Surgery, Donostia University Hospital, Deusto University - School of Medicine, BioGuipuzcoa Research Institute, San Sebastian, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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2
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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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3
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Araujo-Castro M, Redondo López S, Pascual-Corrales E, Polo López R, Alonso-Gordoa T, Molina-Cerrillo J, Moreno Mata N, Caballero Silva U, Barberá Durbán R. Surgical and non-surgical management of thoracic and cervical paraganglioma. ANNALES D'ENDOCRINOLOGIE 2022:S0003-4266(22)00857-5. [PMID: 36334803 DOI: 10.1016/j.ando.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
Thoracic and cervical paragangliomas (PGLs) are rare neuroendocrine tumors arising from chromaffin cells of the neural crest progenitors located outside the adrenal gland. We describe our current protocol as a multidisciplinary team for the management of cervical and thoracic PGLs. Surgery is generally considered the treatment of choice as it offers the best chance for cure. For resection of thoracic PGLs, video-assisted thoracoscopic surgery (VATS) is the main surgical approach, while open thoracotomy is preferred in case of tumors > 6cm, lacking confirmation of a plane of separation with adjacent structures, or with technical difficulties during VATS. In cervical PGLs, the surgical approach should be individualized according to location, mainly based on the Glasscock-Jackson and the Fisch-Mattox classifications. Surgery is the treatment of choice for most cervical and thoracic PGLs, but radiotherapy or observation could be more suitable options in unresectable cervical and thoracic PGLs or when resection has been incomplete.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Division, Department of Endocrinology & Nutrition & IRYCIS, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Madrid, Spain.
| | - Sandra Redondo López
- Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Eider Pascual-Corrales
- Neuroendocrinology Division, Department of Endocrinology & Nutrition & IRYCIS, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Madrid, Spain
| | - Rubén Polo López
- Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Teresa Alonso-Gordoa
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal & IRYCIS, Madrid, Spain
| | - Javier Molina-Cerrillo
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal & IRYCIS, Madrid, Spain
| | - Nicolás Moreno Mata
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Usue Caballero Silva
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rafael Barberá Durbán
- Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Altoijry A, Alghofili H, Iqbal K, Altuwaijri T, Aljabri B, Al-Salman M. Carotid body tumor encounters over a two-decade period in an academic hospital. Medicine (Baltimore) 2022; 101:e31110. [PMID: 36254026 PMCID: PMC9575837 DOI: 10.1097/md.0000000000031110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Carotid body tumors (CBTs) are rare and mostly benign. Research outcomes usually arise from single-center data. We conducted this study to present the characteristics and outcomes of patients who underwent surgical resection of CBT at our hospital over the past 20 years. In this retrospective review, the records of CBTs in our hospital were reviewed between 1998 and 2021. All patients who underwent CBT resection were included. The follow-up period was 12 months. A total of 44 CBTs were treated in our hospital. The male-to-female ratio was 1:2.4. Only 4.5% of patients had Shamblin I tumors. Patients with Shamblin II and III tumors were 56.8% and 38.6%, respectively. Duplex scan was used to diagnose CBT in all of the patients. The majority of our patients (97.7%) did not receive any preoperative embolization despite an average tumor size of 4.9 cm. Cranial nerve injuries were observed in 29.5% of cases. Meanwhile, stroke was reported in only two cases (4.5%). No deaths were encountered. Surgery is the definitive treatment for CBT. Size and local extension appear to be the main reasons for adverse events rather than surgical techniques. Our results are consistent with those of previously published studies. Good outcomes are expected in high-volume centers with appropriate preoperative imaging.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- * Correspondence: Abdulmajeed Altoijry, Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, PO Box 242069, Riyadh 11322, Saudi Arabia (e-mail: )
| | - Hesham Alghofili
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kaisor Iqbal
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Talal Altuwaijri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Badr Aljabri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mussaad Al-Salman
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Moscona-Nissan A, Saldívar-Rodea CA, Enríquez-García R, Rincón-Ángel LI, Calzada AN, Seidman-Sorsby A, Cruz-Zermeño M. Bilateral carotid body tumor case: A novel preoperative management. Radiol Case Rep 2022; 17:1021-1029. [PMID: 35140832 PMCID: PMC8813562 DOI: 10.1016/j.radcr.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Paragangliomas are rare neuroendocrine neoplasms. The most common form of these tumors in head and neck are non-functional carotid body tumors. These neoplasms may present an extensive growth and compromise vital neurovascular structures in the neck, such as carotid vessels. Carotid body tumors usually present clinically as painless neck masses and occur most frequently in adults averaging 45 to 50 years, being the majority of these tumors unilateral and only 5% of all cases bilateral. The main treatment for carotid body paragangliomas is surgical resection, which can be extremely challenging due to tumor hypervascularity and significant blood loss. We present a bilateral carotid body tumor case in a 61-year-old woman who presented due to a pulsatile and painless mass in the right carotid region of the neck of 1-year of evolution. The tumor was found encasing the external carotid artery and classified as Shamblin II. A novel approach for preoperative management was performed, placing a covered graft-stent in the right common and proximal (C1) internal carotid arteries in order to splint and provide structural protection for carotid vessels during surgical resection and temporarily reduce blood flow of the carotid body tumor.
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Affiliation(s)
- Alberto Moscona-Nissan
- School of Medicine, Universidad Panamericana, Mexico City, Mexico
- Corresponding author. Alberto Moscona-Nissan.
| | - Carlos A Saldívar-Rodea
- Interventional Radiology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Rocío Enríquez-García
- Interventional Radiology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
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6
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Lozano FS, Muñoz A, de Las Heras JA, González-Porras JR. Simple and complex carotid paragangliomas. Three decades of experience and literature review. Head Neck 2020; 42:3538-3550. [PMID: 32812684 DOI: 10.1002/hed.26421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. METHODS Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. RESULTS Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. CONCLUSIONS Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.
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Affiliation(s)
- Francisco S Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Angel Muñoz
- Department of Otorhinolaryngology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José A de Las Heras
- Department of Radiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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7
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Snezhkina AV, Lukyanova EN, Zaretsky AR, Kalinin DV, Pokrovsky AV, Golovyuk AL, Krasnov GS, Fedorova MS, Pudova EA, Kharitonov SL, Melnikova NV, Alekseev BY, Kiseleva MV, Kaprin AD, Dmitriev AA, Kudryavtseva AV. Novel potential causative genes in carotid paragangliomas. BMC MEDICAL GENETICS 2019; 20:48. [PMID: 30967136 PMCID: PMC6454587 DOI: 10.1186/s12881-019-0770-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Carotid paragangliomas (CPGLs) are rare neuroendocrine tumors that arise from the paraganglion at the bifurcation of the carotid artery and are responsible for approximately 65% of all head and neck paragangliomas. CPGLs can occur sporadically or along with different hereditary tumor syndromes. Approximately 30 genes are known to be associated with CPGLs. However, the genetic basis behind the development of these tumors is not fully elucidated, and the molecular mechanisms underlying CPGL pathogenesis remain unclear. Methods Whole exome and transcriptome high-throughput sequencing of CPGLs was performed on an Illumina platform. Exome libraries were prepared using a Nextera Rapid Capture Exome Kit (Illumina) and were sequenced under 75 bp paired-end model. For cDNA library preparation, a TruSeq Stranded Total RNA Library Prep Kit with Ribo-Zero Gold (Illumina) was used; transcriptome sequencing was carried out with 100 bp paired-end read length. Obtained data were analyzed using xseq which estimates the influence of mutations on gene expression profiles allowing to identify potential causative genes. Results We identified a total of 16 candidate genes (MYH15, CSP1, MYH3, PTGES3L, CSGALNACT2, NMD3, IFI44, GMCL1, LSP1, PPFIBP2, RBL2, MAGED1, CNIH3, STRA6, SLC6A13, and ATM) whose variants potentially influence their expression (cis-effect). The strongest cis-effect of loss-of-function variants was found in MYH15, CSP1, and MYH3, and several likely pathogenic variants in these genes associated with CPGLs were predicted. Conclusions Using the xseq probabilistic model, three novel potential causative genes, namely MYH15, CSP1, and MYH3, were identified in carotid paragangliomas.
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Affiliation(s)
| | - Elena N Lukyanova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Andrew R Zaretsky
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Dmitry V Kalinin
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Anatoly V Pokrovsky
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander L Golovyuk
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - George S Krasnov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Maria S Fedorova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Elena A Pudova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Sergey L Kharitonov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Nataliya V Melnikova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Boris Y Alekseev
- National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Marina V Kiseleva
- National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Andrey D Kaprin
- National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexey A Dmitriev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Anna V Kudryavtseva
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia.
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8
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Metheetrairut C, Chotikavanich C, Keskool P, Suphaphongs N. Carotid body tumor: a 25-year experience. Eur Arch Otorhinolaryngol 2015; 273:2171-9. [DOI: 10.1007/s00405-015-3737-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
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9
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González-Orús Álvarez-Morujo R, Arístegui Ruiz M, Martin Oviedo C, Álvarez Palacios I, Scola Yurrita B. Management of vagal paragangliomas: review of 17 patients. Eur Arch Otorhinolaryngol 2014; 272:2403-14. [PMID: 24973966 DOI: 10.1007/s00405-014-3141-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022]
Abstract
Vagal paragangliomas are very rare benign vascular tumors of neuroendocrine nature, and are much less frequent than carotid and jugulo-tympanic tumors. The goal of this retrospective study is to review the clinical and genetic findings, surgical treatment, and complications of vagal paragangliomas, as well as to discuss the management options. During the period 1990-2013, 17 patients with vagal paragangliomas were referred to our institution. There were ten patients with isolated tumors, and seven with multicentric paragangliomas. There were nine women and eight men. Mean age of patients was 51.4 years. Five cases had a positive family history of paraganglioma (29.4 %). Germline mutations of SDH genes were found in six of our patients (35.3 %). Many options were considered in the management of vagal paragangliomas. Surgical treatment was performed in 11 young patients (64.7 %) using different approaches: in 4 patients the tumor was resected through a transcervical approach; in 3 through a transcervical-transmandibular approach; in 1 it was resected using a transcervical-transmastoid approach, and in 3 a type A infratemporal fossa approach was performed. In all operated cases, the removal of the tumor led to sacrificing of the vagus nerve. Postoperative hypoglossal nerve deficit was reported in 4 cases (36.3 %). In six elderly patients (35.3 %), we decided to "wait-and-scan" in order to avoid creating greater morbidity than that of the tumor itself. Many factors should be considered in the treatment of vagal paragangliomas: the age and general condition of the patient, the biological behavior of the tumor, tumor size, genetic results, bilaterality, multicentricity, lower cranial nerve function, and of course the potential morbidity of the surgical treatment itself. Rehabilitation and, possibly surgery, are necessary to treat postoperative lower cranial nerve deficits.
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Affiliation(s)
- Ricardo González-Orús Álvarez-Morujo
- Department of Otolaryngology, Head and Neck Surgery, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo St, 46, 28007, Madrid, Spain,
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10
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Abstract
Paragangliomas (PGLs) are tumours originating from neural crest-derived cells situated in the region of the autonomic nervous system ganglia. Head-and-neck PGLs (HNPGLs) originate from the sympathetic and parasympathetic paraganglia, most frequently from the carotid bodies and jugular, tympanic and vagal paraganglia, and are usually non-catecholamine secreting. Familial PGLs are considered to be rare, but recently genetic syndromes including multiple PGLs and/or phaeochromocytomas have been more thoroughly characterised. Nowadays, genetic screening for the genes frequently implicated in both familial and sporadic cases is routinely being recommended. HNPGLs are mostly benign, generally slow-growing tumours. Continuous growth leads to the involvement of adjacent neurovascular structures with increased morbidity rates and treatment-related complications. Optimal management mostly depends on tumour location, local involvement of neurovascular structures, estimated malignancy risk, patient age and general health. Surgery is the only treatment option offering the chance of cure but with significant morbidity rates, so a more conservative approach is usually considered, especially in the more difficult cases. Radiotherapy (fractionated or stereotactic radiosurgery) leads to tumour growth arrest and symptomatic improvement in the short term in many cases, but the long-term consequences are unclear. Early detection is essential in order to increase the chance of cure with a lower morbidity rate. The constant improvement in diagnostic imaging, surgical and radiation techniques has led to a safer management of these tumours, but there are still many therapeutic challenges, and no treatment algorithm has been agreed upon until now. The management of HNPGLs requires a multidisciplinary effort addressing the genetic, surgical, radiotherapeutic, oncological, neurological and endocrinological implications. Further progress in the understanding of their pathogenesis will lead to more effective screening and earlier diagnosis, both critical to successful treatment.
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Affiliation(s)
- Cristina Capatina
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
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11
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Suárez C, Rodrigo JP, Mendenhall WM, Hamoir M, Silver CE, Grégoire V, Strojan P, Neumann HPH, Obholzer R, Offergeld C, Langendijk JA, Rinaldo A, Ferlito A. Carotid body paragangliomas: a systematic study on management with surgery and radiotherapy. Eur Arch Otorhinolaryngol 2013; 271:23-34. [PMID: 23420148 DOI: 10.1007/s00405-013-2384-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/23/2013] [Indexed: 12/24/2022]
Abstract
The definitive universally accepted treatment for carotid body tumors (CBT) is surgery. The impact of surgery on cranial nerves and the carotid artery has often been underestimated. Alternatively, a few CBTs have been followed without treatment or irradiation. The goal of this study is to summarize the existing evidence concerning the efficacy and safety of surgery and external beam radiotherapy (EBRT) for CBT. Relevant articles were identified using strict criteria for systematic searches. Sixty-seven articles met the criteria which included 2,175 surgically treated patients. On the other hand, 17 articles including 127 patients treated with EBRT were found. Long-term control of the disease was obtained in 93.8% of patients who received surgical treatment and in 94.5% of the radiotherapy group. Surgery resulted in 483 (483/2,175 = 22.2%) new cranial nerve permanent deficits, whereas in the EBRT group, no new deficits were recorded (p = 0.004). The common/internal carotid artery was resected in 271 (12.5%) patients because of injury or tumor encasement, with immediate reconstruction in 212 (9.7%) patients. Three percent (60) of patients developed a permanent stroke and 1.3% (26) died due to postoperative complications. The major complications rates and the mortality after completion of the treatment also were significantly higher in surgical series compared to EBRT series. This systematic analysis highlights evidence that EBRT offers a similar chance of tumor control with lower risk of morbidity as compared to surgery in patients with CBT. This questions the traditional notion that surgery should be the mainstay of treatment.
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Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias Oviedo, Oviedo, Spain
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12
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Makeieff M, Thariat J, Reyt E, Righini CA. Treatment of cervical paragangliomas. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:308-14. [PMID: 23021979 DOI: 10.1016/j.anorl.2012.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 03/12/2012] [Accepted: 03/21/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Review of the treatment of cervical paraganglioma. MATERIAL AND METHODS Review of the literature based on a Medline database. RESULTS The treatment of choice consists of a multidisciplinary approach based on a detailed clinical, laboratory and radiological work-up. Vascular reconstruction may be necessary when the tumour invades the artery wall. The main complication of surgery is damage to cranial nerves involved in speech and/or swallowing. Treatment of bilateral tumours must be conducted in two stages. The first side to be operated depends on the sites and size of the tumours, as the primary objective is to avoid bilateral vagus nerve palsy. Radiotherapy has been used to treat paragangliomas for several years and achieves tumour stabilization in the majority of cases. Potential indications reported in the literature are: inoperable tumours, recurrence after surgery, some bilateral tumours and malignant tumours. CONCLUSION Surgery is the standard treatment for cervical paraganglioma. Radiotherapy can be proposed when surgery is contraindicated.
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Affiliation(s)
- M Makeieff
- Service d'ORL et de chirurgie cervico-faciale, pôle neuroscience tête et cou, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex, France.
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13
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Schneider R, Ukkat J, Nguyen-Thanh P, Lorenz K, Plontke S, Behrmann C, Sekulla C, Dralle H. [Endocrine surgery for neck paraganglioma: operation, radiation therapy or wait and scan?]. Chirurg 2012; 83:1060-7. [PMID: 22802215 DOI: 10.1007/s00104-012-2326-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Head and neck paraganglioma (HNP) represent rare endocrine tumors. Therapy is decided on genetic findings, tumor characteristics (e.g. tumor size, localization and dignity), age of patient and symptoms. In terms of local control radiation therapy is as equally effective as surgery but surgical morbidity rates secondary to cranial nerve injuries remain high. PATIENTS Based on 6 patients with 11 solitary (4 patients) and multiple (2 patients) HNP (8 carotid body tumors, 1 vagal, 1 jugular and 1 jugulotympanic paraganglioma) the specific characteristics of the need for surgery as well as correct choice of treatment in cases of sporadic succinate dehydrogenase (SDH) negative and hereditary SDH positive HNP will be exemplarily demonstrated. RESULTS A total of 6 carotid body tumors (four sporadic, two hereditary) were resected in 4 patients, five as primary surgery and one as a revision procedure. In one case a preoperative embolization was performed 24 h before surgery. Malignancy could not be proven in any patient. The 30-day mortality was zero. In the patient with bilateral hereditary carotid body tumors, unilateral local recurrent disease occurred. After resection of the recurrent tumor permanent unilateral paralysis of the laryngeal nerve, glossopharyngeal nerve and hypoglossal nerve occurred. All patients were followed-up postoperatively for a mean of 64 months (range 23-78 months) with a local tumor control rate of 100%. The overall survival rate after 5 years was 100%. CONCLUSIONS Given a very strict indication with awareness of surgical risks selective surgery has a key position with low postoperative morbidity in the treatment of HNPs. We prefer surgery for small unilateral paraganglioma, malignant or functioning tumors.
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Affiliation(s)
- R Schneider
- Universitätsklinik und Poliklinik für Allgemein-, Viszeral- und Gefässchirurgie, Martin-Luther-Universität, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland.
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14
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Avgerinos ED, Moulakakis K, Brountzos E, Giannakopoulos TG, Lazaris AM, Koumarianou A, Geronikola-Trapali X, Ptohis N, Papapetrou A, Liapis CD. Advances in assessment and management of carotid body tumors. Vascular 2011; 19:250-6. [DOI: 10.1258/vasc.2011.oa0291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evolving technology has the potential to alter the overall management of carotid body tumors (CBTs). We review our 35-year experience emphasizing on novel modalities available in the evaluation and treatment of CBTs. Medical records of 27 CBT patients between 1975 and 2009 were retrospectively reviewed. The study cohort has been arbitrarily divided into two groups: the early years' group A (18 patients, 1975–1998) and the later years' group B (9 patients, 1999–2009). The most common presenting symptom was a painless lateral neck mass (89%). Octreotide scintigraphy and genetic testing were routinely used for group B. In two cases, octreotide scintigraphy was coupled with intraoperative radiolocalization of the lesion. Preoperative embolization was performed in four CBTs. Among group B patients, five were pretreated via a covered stent placement in the external carotid artery (ECA). Twenty-three patients (24 CBTs) were eventually operated upon. One cardiovascular death, one permanent vocal cord paralysis and six transient cranial nerve injuries account for a 4.4% 30-day mortality and a 30.4% morbidity with no significant differences among groups. In conclusion, appropriate use of new techniques in CBT management has improved diagnostic accuracy and early detection without clearly affecting overall outcome in our study cohort.
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Affiliation(s)
| | | | | | | | | | | | - Xenia Geronikola-Trapali
- Department of Nuclear Medicine, Attikon University Hospital, Athens Medical School, Chaidari, Athens, Greece
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15
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Raza K, Kaliaperumal C, Farrell M, O'Dwyer JA, Pidgeon C. Solitary Paraganglioma of the Hypoglossal Nerve: Case Report. Neurosurgery 2011; 68:E1170-E1174. [DOI: 10.1227/neu.0b013e31820a16b5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 05/04/2010] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumor are discussed and as a literature review provided.
CLINICAL PRESENTATION:
A 64-year-old woman presented with a short history of dysphonia, occasional dysphagia, tinnitus, altered taste, and unilateral left-sided tongue wasting. On examination, there was left lower motor hypoglossal paralysis. Imaging showed a discrete enhancing lobulated mass, measuring 2 × 2 cm, in the region of the hypoglossal nerve extending into the hypoglossal canal suggestive of hypoglossal paraganglioma. A left dorsolateral suboccipital craniotomy was performed with the patient in the sitting position. The hypoglossal nerve appeared to be enlarged, and the jugular foramen was normal. Complete surgical debulking of the tumor was not attempted because of its vascular nature. The nerve was decompressed, and neuropathology confirmed a low-grade paraganglioma arising from the hypoglossal nerve. The patient was scheduled to receive stereotactic radiation for further management.
CONCLUSION:
When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focused on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted on magnetic resonance imaging, a preoperative angiogram should be obtained with a view for embolization. We decompressed the hypoglossal canal and achieved good improvement in the patient's symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumors and regular follow-up with magnetic resonance imaging scans.
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Affiliation(s)
- Kazim Raza
- Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Chandrasekaran Kaliaperumal
- Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Michael Farrell
- Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - John A. O'Dwyer
- Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Christopher Pidgeon
- Department of Neurosurgery, National Centre for Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
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Kakkos SK, Reddy DJ, Shepard AD, Lin JC, Nypaver TJ, Weaver MR. Contemporary presentation and evolution of management of neck paragangliomas. J Vasc Surg 2009; 49:1365-73.e2. [DOI: 10.1016/j.jvs.2009.01.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 01/22/2009] [Accepted: 01/25/2009] [Indexed: 11/24/2022]
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17
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Santovito D, Conforti M, Varetto G, Rispoli P. Paraganglioma of the hypoglossal nerve. J Vasc Surg 2009; 49:1053-5. [PMID: 19341894 DOI: 10.1016/j.jvs.2008.11.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 11/15/2008] [Accepted: 11/17/2008] [Indexed: 11/28/2022]
Abstract
After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searched our hospital database and literature for similar cases to determine whether evidence exists to support the existence of paraganglioma of the hypoglossal nerve. We describe a case of cranial nerve XII paraganglioma, recognized only during surgery, without any indicative preoperative sign or symptom nor diagnostic imaging studies. In light of published findings, only four cases described since 1966, and our experience, the report discusses diagnostic criteria that could aid in establishing a diagnosis of hypoglossal nerve paraganglioma based on a reasonable degree of medical certainty.
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Affiliation(s)
- Davide Santovito
- Unit of Vascular Surgery, Department of Medico-Surgical Disciplines, University of Turin, Turin, Italy
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Davidovic L, Ilic N, Dimitrijevic M, Dukic V, Dzodic R. Surgical management of cervical paragangliomas. Am Surg 2009; 74:1171-6. [PMID: 19097531 DOI: 10.1177/000313480807401208] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carotid body tumors are rare, but represent the most common form of head and neck paraganglioma. We present 17 surgically treated patients. The present study reviews our experience in the diagnosis and treatment of these uncommon lesions. At surgery, 11 tumors were classified as Shamblin Class II and six as Class III. A cerebral angiogram was obtained in all cases before surgery. A cervical approach was the method of choice in 16 cases; in one case with mediastinal extension of the tumor we used a combined cervical and transsternal approach. Complete excision of the tumor was accomplished in all cases. Subadventitial tumor excision was performed in eight cases whereas internal carotid artery reconstruction was obtained in eight cases (three saphenous interposition vein grafts, two polytetrafluoroethylene (PTFE) 6 mm grafts, and end-to-end anastomosis in three cases). Resection of the left common carotid artery and reconstruction with a Dacron 8 mm graft was performed in the case with mediastinal tumor extension. Duplex scan along with angiography is effective in making the diagnosis. Excision is indicated for most tumors, and best results are achieved by an experienced vascular surgeon.
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Affiliation(s)
- Lazar Davidovic
- Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade.
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Lozano FS, Gómez JL, Mondillo MC, González-Porras JR, González-Sarmiento R, Muñoz A. Surgery of vagal paragangliomas: Six patients and review of literature. Surg Oncol 2008; 17:281-7. [DOI: 10.1016/j.suronc.2008.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Revised: 03/12/2008] [Accepted: 03/13/2008] [Indexed: 11/15/2022]
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20
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Pinto FR, de Aquino Capelli F, Maeda SA, Pereira EM, Scarpa MB, Brandão LG. Unusual location of a cervical paraganglioma between the thyroid gland and the common carotid artery: case report. Clinics (Sao Paulo) 2008; 63:845-8. [PMID: 19061012 PMCID: PMC2664290 DOI: 10.1590/s1807-59322008000600024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Sueli Aparecida Maeda
- Department of Pathology, Salomão & Zoppi Medicina Diagnóstica - São Paulo/SP, Brazil
| | | | | | - Lenine Garcia Brandão
- Head and Neck Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil.
, Tel.: 55 11 5058.5738
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Tomita T, Ozawa H, Tagawa T, Sakamoto K, Ogawa K. [A multidisciplinary approach to carotid body tumors. Report of five cases]. NIHON JIBIINKOKA GAKKAI KAIHO 2008; 110:743-51. [PMID: 18186291 DOI: 10.3950/jibiinkoka.110.743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We performed a retrospective review of five patients with carotid body tumors at our institution between 1997 and 2005. Out of the five patients, three patients were treated by surgical resection of the tumor, and 2 patients were observed. It would seem that it is difficult to suspect this disease based only on the clinical findings, because the disease was suspected in only one patient at the first medical examination. Imaging tests are important for establishment of the diagnosis. Color Doppler sonography and MR angiography in addition to MRI are useful. Angiography and balloon Matas test are important for selection of candidates for the operation. The resected tumors were all classified in Shamblin's group II. Delayed cerebral infarction was caused in one patient postoperatively, although the carotid artery was preserved. The dissection in a tumor-adventitial plane using the bipolar coagulation technique under the microscope was performed in the other two cases. Histological examination of the specimen revealed no tumor cells in the excision stump. Dissection in the tumor-adventitial plane using bipolar coagulation under the microscope is important for carotid artery preservation and radical resection of Shamblin's group I and II tumors. It is necessary to compare the risk of the operation with the problems of observation in the process of decision making and to achieve reliable informed consent. Moreover, it is necessary to examine the indications for operation in individual cases referring to the age, past history, expected Shamblin's classification, and result of the balloon Matas test. A multidisciplinary approach should be used, involving the fields of otolaryngology, radiology, neurosurgery and vascular surgery to treat these patients.
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Affiliation(s)
- Toshiki Tomita
- Department of Otolaryngology, Keio University School of Medicine, Tokyo
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Martínez-Aguilar E, March-García J, de Haro-Miralles J, Flórez-González A, Varela-Casariego C, Acín F. Paraganglioma carotídeo familiar. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)02007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Cervical paragangliomas: is SDH genetic analysis systematically required? Eur Arch Otorhinolaryngol 2007; 265:557-63. [DOI: 10.1007/s00405-007-0517-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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