Changes in Voice After Septoplasty: A Pilot Study

Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature

“…Therefore, future directions to anticipate as much as possible the diagnosis of MCBTs should include: (1) at the patient level, in every cervical paraganglioma carrier, systematically addressing possible genetic mutations, testing catecholamine secretion, and intensively searching for possible multifocal disease since these are all well-known risk factors for an increased malignant potential 166,167 ; (2) at the tumor level, continuing the search for possible hallmarks predictive of the malignant potential of such lesions, for example quantifying superoxide anions (whose higher concentration is directly linked to SDHx mutations and ensuing more frequent DNA mutations) within the CBT surgical specimen using a fluorogenic dye as recently described by Kajal and coworkers 168 or evaluating the matrix metalloproteinases-1, -2, and -3 levels in plasma and tissue samples (found to be significantly higher in MCBTs by Serra et al) 91 ; (3) at the nodal level, following the recommendations of performing at least a prophylactic level IIA sampling, potentially extended to a selective neck dissection of levels II-III for diagnostic purposes in every CBT 30,37,70,81,138,159,169,170 ; (4) at the metastatic level, applying as much as possible a diagnostic work-up and/or follow-up including Gallium 68 labeled 1,4,7,10-tetraazacy-cloDOdecane-1,4,7,10-Tetraacetic Acid-NaI-OCtreotide Positron Emission Tomography/Computed Tomography (Ga-68 DOTANOC PET/CT). 171 As a general rule, special attention to exclude MCBT should be given to lesions with presentation at the extremes of age, gross infiltrative and aggressive behavior into the surrounding neck structures, multifocal nature, association with family history (in particular SDHB or SDHD genes mutations), and size >4 cm with Shamblin III classification (Figure 5A,B).…”