Unilateral synchronous masses of the neck revealing a malignant Carotid Body Tumor: A case report and literature review

Incidental Cytodiagnosis of Carotid Body Tumour on Fine Needle Aspiration Cytology

A carotid body tumor is a rare form of neoplasm that arises near the carotid artery bifurcation and it has an incidence rate of less than 0.3 per 100,000 population. The low incidence rate of such tumors is due to their origination from the paraganglion cells which is relatively uncommon as compared to other forms of tumor. Here we present an incidental and unusual cytodiagnosis of carotid body tumors. A 45-year-old male presented to the surgery outpatient department with swelling in the left-sided anterior region of the neck. The swelling was gradually progressing over three years and was insidious. Clinically the swelling was 3 cm x 3 cm in size and the patient complained of pain in the last two months which was intermittent. The patient was sent to the cytopathology section for fine needle aspiration cytology with the clinical diagnosis of tubercular lymphadenopathy. The patient underwent fine needle aspiration cytology by 26 SW needle by standard institutional protocols. The cytodiagnosis of "Paraganglioma/ Carotid Body Tumour" was offered. Histomorphological features at excision were consistent with carotid body tumors (paraganglioma). The sections of the tumor immunohistochemically were positive for neuron-specific enolase. The incidental cytodiagnosis of carotid body tumors is reported in the literature sparsely. This case is presented for the cytomorphology of carotid body tumor which is unfamiliar to the reporting pathologist because of its rare occurrence.

The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis

BACKGROUND

Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs).

METHODS

We retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated.

RESULTS

CBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, - 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors.

CONCLUSIONS

CDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.