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Paragangliomas of the Carotid Body: Current Management Protocols and Review of Literature

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Abstract

Paraganglioma is a rare neoplasm arising from carotid body usually benign and constitute 0.5 % of all total body tumors. They constitute 60–70 % of head and neck paraganglioma and resemble other paragangliomas of the body like glomus jugulare, glomus tympanicum, and pheochromocytoma. This is a retrospective analysis of the medical records of carotid body paraganglioma cases. Nine patients operated during the study period and the follow up traced were included in the study. Seven females and 2 males were analysed. Six had tumor on the left side and 3 had on the right side. All the cases surgical excision was done by a tranverse incision as 2 patients had Shamblin I, 5 patients had Shamblin II, and 1 patients Shamblin IIIa. All the Shamblin I had tumor away from the carotids and were easily dissected without vessel damage, a sub adventitial tumor excision was performed in all the 5 cases of Shamblin II, 1 case of Shamblin IIIa was dissected with difficulty without sacrificing or vessel reconstruction. Paraganglioma of the carotid body should be considered as a differential diagnosis for painless lateral neck masses. Larger tumors need a multidisciplinary team of head and neck with vascular surgeons for better results.

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References

  1. Albsoul NM, Alsmady MM, Al-Aardah MI (2009) Carotid body paraganglioma management and outcome. Eur J Sci Res 37(4):567–574, ISSN 1450-216X

    Google Scholar 

  2. Sykes JM, Ossoff RH (1986) Paragangliomas of the head and neck. Otolaryngol Clin N Am 19:755–767

    CAS  Google Scholar 

  3. Sobol SM, Dailey JC (1990) Familial multiple cervical paragangliomas: report of a kindred and review of the literature. Otolaryngol Head Neck Surg 102:382–390

    PubMed  CAS  Google Scholar 

  4. Myers EN, Johnson JT (1993) In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE (eds) Neoplasms. Otolaryngology-head and neck surgery. Mosby Year Book, St Louis, pp 1590–1597

    Google Scholar 

  5. Kyriakos M (1987) Pathology of selected soft tissue tumors of the head and neck. In: Thawley SE, Panje WR (eds) Comprehensive management of head and neck tumors. W.B. Saunders, Philadelphia, pp 1261–1264

    Google Scholar 

  6. Maves MD (1993) Vascular tumors of the head and neck. In: Bailey BJ, Johnson JT, Kohut RI, Pillsbury HC, Tardy ME (eds) Head and neck surgery-otolaryngology. JB Lippincott, Philadelphia, pp 1397–1409

    Google Scholar 

  7. Rush BF Jr (1962) Current concepts in the treatment of carotid body tumors. Surgery 52:679

    PubMed  Google Scholar 

  8. Attia AA, Abdalla H, Mamoun S, El-Sebai H (2001) Carotid body ganglioma. J Egypt Natl Cancer Inst 13(2):79–84

    Google Scholar 

  9. Milewski C (1993) Morphology and clinical aspects of paragangliomas in the area of head-neck. HNO 41:526–531

    PubMed  CAS  Google Scholar 

  10. Balatsouras DG, Eliopoulos PN, Economou CN (1992) Multiple glomus tumors. J Laryngol Otol 106:538–543

    Article  PubMed  CAS  Google Scholar 

  11. Mayer R, Fruhwirth J, Beham A, Groell R, Poschauko J, Hackl A (2000) Radiotherapy as adjunct to surgery for malignant carotid body paragangliomas presenting with lymph node metastases. Strahlenther Onkol 176:356–360

    Article  PubMed  CAS  Google Scholar 

  12. Pacheco-Ojeda L (2001) Malignant carotid body tumors: report of 3 cases. Ann Otol Rhinol Laryngol 110:36–40

    PubMed  CAS  Google Scholar 

  13. Davidovic LB, Djukic VB, Vasic DM, Sindjelic RP, Duvnjak SN (2005) Diagnosis and treatment of carotid body paraganglioma: 21 years of experience at a clinical center of Serbia. World J Surg Oncol 3:10. doi:10.1186/1477-7819-3-10

    Article  PubMed  Google Scholar 

  14. Kairemo KJA, Hopsu EVM (1990) Radioimmunodetection of chemodectoma by In-111 labeled anti-CEA antibody. Clin Nucl Med 15:900–903

    Article  PubMed  CAS  Google Scholar 

  15. Saldana MJ, Salem LE, Travezan R (1973) High altitude hypoxia and chemodectomas. Hum Pathol 4:251–263

    Article  PubMed  CAS  Google Scholar 

  16. Heath D (1991) The human carotid body in health and disease. J Pathol 164:1–8

    Article  PubMed  CAS  Google Scholar 

  17. Patetsios P, Gable DR, Garrett WV, Lamont JP, Kuhn JA, Shutze WP (2002) Management of carotid body paragangliomas and reviews of 30 year experience. Ann Vasc Surg 16(3):331–338

    Article  PubMed  Google Scholar 

  18. Dimakakos P, Kotsis T (2001) Carotid body paraganglioma: review and surgical management. Eur J Plast Surg 24:58–65

    Article  Google Scholar 

  19. Masilamani S, Duvuru P, Sundaram S (2012) Fine needle aspiration cytology diagnosis of a case of carotid body tumour. Singap Med J 53(2):e36

    Google Scholar 

  20. Por YC, Lim DT, Teoh MK, Soo KC (2002) Surgical management and outcome of carotid body tumours. Ann Acad Med Singap 31:141–144

    PubMed  CAS  Google Scholar 

  21. Rosa M, Sahoo S (2008) Bilateral carotid body tumour: the role of fine-needle aspiration biopsy in the preoperative diagnosis. Diagn Cytopathol 36:178–180

    Article  PubMed  Google Scholar 

  22. Jayaram G, Kaliaperumal S, Kumar G (2005) Bilateral carotid body tumour diagnosed on cytology. Acta Cytol 49:690–692

    PubMed  Google Scholar 

  23. Das DK, Gupta AK, Chowdhury V et al (1997) Fine-needle aspiration diagnosis of carotid body tumour: report of a case and review of experience with cytologic features in four cases. Diagn Cytopathol 17:143–147

    Article  PubMed  CAS  Google Scholar 

  24. Muhm M, Polterauer P, Gstöttner W et al (1997) Diagnostic and therapeutic approaches to carotid body tumours. Review of 24 patients. Arch Surg 132:279–284

    Article  PubMed  CAS  Google Scholar 

  25. Westerband A, Hunter GC, Citora I et al (1998) Current trends in the detection and management of carotid body tumors. J Vasc Surg 28(1):84–92

    Article  PubMed  CAS  Google Scholar 

  26. Kotelis D, Rizos T, Geisbüsch P, Attigah N, Ringleb P, Hacke W, Allenberg JR, Böckler D. Late outcome after surgical management of carotid body tumors from a 20-year single-center experience. Langenbeck’s Arch Surg. 2008 Jul 17

  27. Kawai A, Healey J, Wilson S, Huvos A, Yeh S (1998) Carotid body paraganglioma metastatic to the bone: report of two cases. Skeletal Radiol 27:103–107

    Article  PubMed  CAS  Google Scholar 

  28. Kafie FE, Freischlag JA (2001) Carotid body tumors: the role of preoperative embolization. Ann Vasc Surg 15:237–242

    Article  PubMed  CAS  Google Scholar 

  29. Niemann S, Muller U (2000) Mutations in SDHC cause autosomal dominant paraganglioma, type 3. Nat Genet 26(3):268–270

    Article  PubMed  CAS  Google Scholar 

  30. Astuti D, Latif F, Dallol A et al (2001) Gene mutations in the succinate dehydrogenase subunit SDHB cause susceptibility to familial pheochromocytoma and to familial paraganglioma. Am J Hum Genet 69:49–54

    Article  PubMed  CAS  Google Scholar 

  31. Hao HX, Khalimonchuk O, Schraders M et al (2009) SDH5, a gene required for flavination of succinate dehydrogenase, is mutated in paraganglioma. Science 325:1139–1142

    Article  PubMed  CAS  Google Scholar 

  32. Schiavi F, Boedeker CC, Bausch B, Peczkowska M, Gomez CF, Strassburg T et al (2005) Predictors and prevalence of paraganglioma syndrome associated with mutations of the SDHC gene. JAMA 294(16):2057–2063. doi:10.1001/jama.294.16.2057

    Article  PubMed  CAS  Google Scholar 

  33. Naji M, Zhao C, Welsh SJ, Meades R, Win Z, Ferrarese A et al (2011) (68)Ga- DOTA-TATE PET vs. (123)I-MIBG in identifying malignant neural crest tumours. Mol Imaging Biol 13(4):769–775

    Article  PubMed  Google Scholar 

  34. Pollard PJ, Briere JJ, Alam NA et al (2005) Accumulation of Krebs cycle intermediates and over-expression of HIF1alpha in tumours which result from germline FH and SDH mutations. Hum Mol Genet 14:2231–2239

    Article  PubMed  CAS  Google Scholar 

  35. Selak MA, Armour SM, MacKenzie ED et al (2005) Succinate links TCA cycle dysfunction to oncogenesis by inhibiting HIF-alpha prolyl hydroxylase. Cancer Cell 7:77–85

    Article  PubMed  CAS  Google Scholar 

  36. Semenza GL (2007) HIF-1 mediates the Warburg effect in clear cell renal carcinoma. J Bioenerg Biomembr 39:231–234

    Article  PubMed  CAS  Google Scholar 

  37. Bayley JP, Devilee P (2010) Warburg tumours and the mechanisms of mitochondrial tumour suppressor genes. Barking up the right tree? Curr Opin Genet Dev

  38. Sajid MS, Hamilton G, Baker DM, On Behalf Of Joint Vascular Research G (2007) A multicenter review of carotid body tumor management. Eur J Vasc Endovasc Surg 34:127–130

    Article  PubMed  CAS  Google Scholar 

  39. Gordon-Taylor G (1940) On carotid tumors. Br J Surg 28:163–172

    Article  Google Scholar 

  40. Kollert M, Minovi A, Mangold R, Hendus J, Draf W, Bockmühl U (2006) Cervical paragangliomas—tumor control and long-term functional results after surgery. Skull Base 16:185–192

    Article  PubMed  Google Scholar 

  41. Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, Herrera-Gomez A (2006) Does Shamblin’s classification predict postoperative morbidity in carotid body tumors? a proposal to modify Shamblin’s classification. Eur Arch Otorhinolaryngol 263:171–175

    Article  PubMed  Google Scholar 

  42. Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V (2005) Carotid body tumors: review of a 20-year experience. Oral Oncol 41:56–61

    Article  PubMed  Google Scholar 

  43. Pandey M, Chandramohan K, Sebastian P, Ramachandran K (2002) An unusual bilateral cervical paraganglioma: a case report. Int J Oral Maxillofac Surg 31:335–337

    Article  Google Scholar 

  44. Christie A, Teasdale E (2010) A comparative review of multidetector CT angiography and MRI in the diagnosis of jugular foramen lesions. Clin Radiol 65(3):213–217

    Article  PubMed  CAS  Google Scholar 

  45. Defraigne JO, Sakalihassan N, Antoine P, Thiry A, Limet R (1997) Carotid chemodectomas. Experience with nine cases with reference to preoperative embolization and malignancy. Acta Chir Belg 97:220–228

    PubMed  CAS  Google Scholar 

  46. Abud DG, Mounayer C, Benndorf G, Piotin M, Spelle L, Moret J (2004) Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas. AJNR Am J Neuroradiol 25:1457e62

    Google Scholar 

  47. Valavanis A (1986) Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions. AJNR Am J Neuroradiol 7:943e52

    Google Scholar 

  48. Rimbot A, Mounayer C, Loureiro C et al (2007) Preoperative mixed embolization of a paraganglioma using Onyx. J Neuroradiol 34:334–339

    Article  PubMed  CAS  Google Scholar 

  49. Casasco A, Herbreteau D, Houdart E et al (1994) Devascularization of craniofacial tumors by percutaneous tumor puncture. AJNR Am J Neuroradiol 15:1233–1239

    PubMed  CAS  Google Scholar 

  50. George B, Casasco A, Deffrennes D et al (1994) Intratumoral embolization of intracranial and extracranial tumors: technical note. Neurosurgery 35:771–773

    Article  PubMed  CAS  Google Scholar 

  51. Wax MK, Briant TD (1992) Carotid body tumors: a review. J Otolaryngol 21(4):277–285

    PubMed  CAS  Google Scholar 

  52. Zabel A, Milker-Zabel S, Huber P, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J (2004) Fractionated stereotactic conformal radiotherapy in the management of large chemodectomas of the skull base. Int J Radiat Oncol Biol Phys 58:1445–1450

    Article  PubMed  Google Scholar 

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Correspondence to Sudhir M. Naik.

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Naik, S.M., Shenoy, A.M., Nanjundappa et al. Paragangliomas of the Carotid Body: Current Management Protocols and Review of Literature. Indian J Surg Oncol 4, 305–312 (2013). https://doi.org/10.1007/s13193-013-0249-4

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  • DOI: https://doi.org/10.1007/s13193-013-0249-4

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