Malignant vagal paraganglioma

Walsh, R. M.; Leen, Edward J.; Gleeson, Michael; Shaheen, O. H.

doi:10.1017/s0022215100136527

Cited by 26 publications

(6 citation statements)

References 41 publications

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“…Malignant PGs tend to show foci at necrosis, vascular invasion, and abundant mitotic figures [3,27]. However, several authors suggest that there are no histological differences between the benign and malignant PGs, the only diagnostic criterion in favor of malignancy being the presence of local recurrence or distant metastases [2,3,28,29]. In the present case, we did not observe infiltration of surgical resection margins and invasion of perithyroid tissues beyond the thyroid capsule, any metastases, vascular invasion, and necrosis.…”

Section: Discussionsupporting

confidence: 40%

Primary thyroid paraganglioma presenting with double thyroid nodule: a case report

Erem

Koçak

Nuhoğlu

et al. 2009

Endocr

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Paragangliomas (PGs) are exceptionally rare tumors. Only 24 cases have previously been reported. Both preoperative and postoperative differential diagnosis is very difficult. Due to interesting nature in diagnosis and differential diagnosis, we describe the case 58-year-old euthyroid woman with a thyroid PG. The patient had presented with euthyroid multinodular goiter to a secondary hospital. The patient was treated with right lobectomy, isthmectomy, and left partial lobectomy without any imaging procedures. No complication had been developed during and following the operation. Initial pathological examination suggested medullar thyroid carcinoma (MTC) in a nodule of 4.5 cm in diameter on right thyroid lobe and a nodule of 2.5 cm in diameter on the left thyroid lobe without amyloid stroma and referred to our third-stage hospital. Repeated pathological examination involving immunohistochemistry revealed that the tumor was stained positively to neuron-specific enolase, chromogranin A, synaptophysin, and S-100 protein. No immunoreactivity was detected against thyroglobulin, calcitonin, parathormone, carcino-embryonic antigen, thyroid transcription factor-1, and cytokeratin. A diagnosis of thyroid PG was finally made. Laboratory analyses and imaging procedures excluded any neck or extracervical tissues metastasis or multiple endocrine neoplasia. In conclusion, thyroid PG is an elusive tumor. We present this interesting nature thyroid PG case to highlight importance of careful evaluation of clinical and pathological findings to correctly identify paragangliomas which anatomically mimic MTCs. This report is the first case of thyroid PG presenting with multinodular goiter in the literature.

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Section: Discussionsupporting

confidence: 40%

Primary thyroid paraganglioma presenting with double thyroid nodule: a case report

Erem

Koçak

Nuhoğlu

et al. 2009

Endocr

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“…About 10% of paraganglioma patients have bilateral or multicentric disease, and about 10% of paragangliomas are malignant and may metastasise. There is also a 10% likelihood of familial disease, in which case there is an increased likelihood of multicentricity, which may be seen in as many as 32%-78% of such cases [1,5,6,7,8]. Early symptoms include pulsesynchronous tinnitus, progressive hearing loss in cases of glomus tympanicum or hypotympanicum paraganglioma or a non-tender neck mass if there is a glomus vagale or a glomus caroticum paraganglioma [1,7,9].…”

Section: Introductionmentioning

confidence: 99%

Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas

Schmidt

Fischer

Dietlein

et al. 2002

European Journal of Nuclear Medicine and Molecular Imaging

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Paragangliomas or glomus tumours of the head and neck region are rare somatostatin receptor-expressing neuroendocrine tumours. Precise preoperative diagnosis is of special importance in order to adequately weigh the potential benefit of the operation against the inherent risks of the procedure. In this study, the clinical value of somatostatin receptor imaging was assessed in 19 patients who underwent somatostatin receptor scintigraphy because of known or suspected paraganglioma of the head and neck region. The results were compared with the results of computed tomography and/or magnetic resonance imaging, histology and clinical follow-up. [(111)In-DTPA- D-Phe(1)]-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 140-220 MBq (111)In-octreotide. Whole-body and planar images as well as single-photon emission tomography images were acquired and lesions were graded according to qualitative tracer uptake. Somatostatin receptor imaging was positive in nine patients, identifying paragangliomas for the first time in three patients and recurrent disease in six patients. In one patient, a second, previously unknown paraganglioma site was identified. Negative results were obtained in ten patients. These patients included one suffering from chronic hyperplastic otitis externa, one with granuloma tissue and an organised haematoma, one with an acoustic neuroma, one with an asymmetric internal carotid artery, two with ectasia of the bulbus venae jugularis and one with a jugular vein thrombosis. In two patients with a strong family history of paraganglioma, individual involvement could be excluded. In only one patient did somatostatin receptor imaging and magnetic resonance imaging yield false negative results in respect of recurrent paraganglioma tissue. It is concluded that somatostatin receptor scintigraphy provides important information in patients with suspected paragangliomas of the head and neck region and has a strong impact on further therapeutic management.

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“…Malignant paragangliomas are also a recognized cause of death from regional and distant metastases. 14 Surgical morbidity associated with vagal deficits is unavoidable. Both our experience and that reported in the literature show that vagal function cannot be preserved even when the nerve is anatomically intact.…”

Section: Discussionmentioning

confidence: 99%