High Altitude Carotid Body Tumors Growth During active Surveillance

Abstract

Background The gold standard for patients with carotid body tumors (CBT) is surgical resection; nevertheless, some patients are unfit for surgery or, for other reasons, could not be operated on. Active surveillance has been known to be a reasonable strategy for these cases. This study aimed to evaluate tumor growth in unoperated patients with CBTs. Methods A retrospective review of all unoperated patients with CBT from a single academic hospital diagnosed between 2014 and 2021 was performed. Results of nonparametric testing were presented using the median and ranges for Mann-Whitney-U or Kruskal-Wallis. Significance was defined as a 2-tailed P < .05. Results The cohort included a total of 31 patients, with a median age of 60 years (range: 37-80 years), of which 27 (87.1%) were females. The patients live at a median altitude of 2800 meters (range: 2756-2980 meters) above sea level. Twenty (64.5%) patients had Shamblin I tumors, eight (25.8%) patients had Shamblin II tumors, and three (9.7%) patients had Shamblin III tumors. Median CBT volume at diagnosis was 14.1 cm3 (range: .9 - 213.3 cm3). Median volume at diagnosis of symptomatic tumors was substantially larger than asymptomatic tumors, 49.2 cm3 vs 7.9 cm3, respectively (P = .03). Median growth of the tumors during a median 15-month follow-up (range: 3-43 months) was 3.3 cm3 (range: 0-199.9 cm3). Overall, 77% (n = 24) of the CBTs grew at least 1 cm3. Conclusion Most patients in the present study had tumor growth by at least 1 cm3, with a median tumor growth of 3.3 cm.3 In the present study tumor growth was shown to be greater than other low altitude CBT active surveillance studies; therefore, surgical resection should be recommended in patients with CBT living at high altitudes.

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

“…The reported annual incidence is 1:30 000 and they represent 60%-78% of all head and neck paragangliomas. [2][3][4][5] CBTs are most frequently benign, unilateral, asymptomatic, highly vascular, slowly growing (roughly 1 mm/year but may grow faster in persons living at high altitudes), 6,7 non-functional tumors, usually located in the anterolateral aspect of the neck, at the level of the carotid bifurcation, from where they can sometimes grow upwards into the parapharyngeal space and/or in close relationships with the skull base and cranial nerves IX, X, XI, and XII. CBT may be distinguished as sporadic (the most frequent form, usually diagnosed with a peak around the 5th decade), familial (mostly diagnosed at a younger age, roughly 30% of the overall CBTs, and known for frequently bilateral occurrence, in combination with vagal and jugulo-tympanic paragangliomas as well as pheochromocytomas), and hyperplastic (secondary to chronic hypoxia in subjects with long-lasting lung disease or living at high altitude).…”

Fabrication of Soft Transparent Patient‐Specific Vascular Models with Stereolithographic 3D printing and Thiol‐Based Photopolymerizable Coatings

“…For instance, transparent vascular models allow surgeons to visualize complex vascular anatomies to plan and practice procedures and reduce the risk of errors during the actual procedures. [ 13 ] Medical residents can also benefit from using these vascular models to understand different pathologies and to learn about various treatments. [ 14–16 ] Medical device companies utilize transparent vascular models to train healthcare professionals effectively and before practicing on animals or patients.…”