Glomus intravagale tumour: aspects of management

Malignant vagal paraganglioma

Vagal paraganglioma is a rare usually benign tumour of neural crest origin. The malignant form of this tumour is very uncommon and the diagnosis is made on the basis of its clinical behaviour rather than its histological appearance. We report a case of vagal paraganglioma metastatic to adjacent cervical nodes and discuss the diagnosis and management of this tumour.

Vagal body tumors

Six cases of vagal body tumor are reviewed. All first presented as painless neck masses with normal cranial nerve function. Otologic symptoms were infrequent, occurring only with temporal bone involvement. In true vagal paragangliomas, cranial nerve and auditory function is usually preserved until there is extensive disease of the skull base. Tumor progression after radiotherapy was documented in four patients, three of whom were treated with 4500 cGy or more. One patient was found to have regional lymph node metastases. The six patients had a total of 10 head and neck paragangliomas, illustrating the high incidence of synchronous and metachronous lesions. Because of the high incidence of multiple lesions, these tumors threaten lower cranial nerves bilaterally in many instances. Because cranial nerve function is preserved until late, and because vagal and accessory nerve paralysis is usually unavoidable with resection, we advocate conservative treatment in selected cases. It may be reasonable to postpone surgery until cranial nerve impairment becomes evident or other vital structures are threatened.