Synchronous malignant vagal paraganglioma with contralateral carotid body paraganglioma treated by radiation therapy

Kataria, Tejinder; Bisht, Shyam Singh; Mitra, Swarupa; Agarwal, Abhishek; Potharaju, Suryaprakash; Chakarvarty, Devlina

doi:10.4081/rt.2010.e21

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…When present, they do suggest a higher risk of malignant behavior [6]. However, malignancy is classically defined by the gross or microscopic evidence of regional or distant metastatic disease [1,3,8].…”

Section: Discussionmentioning

confidence: 99%

Malignant Vagal Paraganglioma

Hamersley

Barrows

Perez

et al. 2015

Head and Neck Pathol

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Paragangliomas are rare, typically benign neuroendocrine tumors that represent a small portion of head and neck tumors. A small percentage of these are known to have malignant potential. They arise from the carotid body, jugular bulb or vagus nerves. There is limited literature discussing the management of malignant vagal paragangliomas. We present a case of a 25 year old female with a left malignant vagal paraganglioma. The following case presentation will describe the presentation, classic radiologic findings, and management of a malignant vagal paraganglioma along with a review of the literature.Keywords Paraganglioma Á Carotid body tumor Á Malignant paraganglioma HistoryA 25 year-old female reported to the emergency department for evaluation of a severe headache. An avid singer, she incidentally complained of difficulty with vocal range and stamina over several months. Family history was negative for head and neck cancer. Physical exam revealed fullness with mild generalized erythema of both the left posterior nasopharynx and the oropharynx. On palpation of the left oropharynx there was no discrete mass, however, the patient endorsed mild tenderness on palpation. Flexible fiberoptic laryngoscopic exam revealed normal bilateral true vocal fold motion and appearance. No cervical lymphadenopathy was appreciated and cranial nerves II-XII were intact. Radiographic FeaturesComputed tomography (CT) identified a 6 9 4 9 3 cm left post-styloid parapharyngeal space avidly enhancing mass (Fig. 1). Magnetic resonance imaging (MRI) confirmed a mass within the left parapharyngeal space that was isointense on T1, slightly hyperintense on T2, and showed multiple flow voids with gadolinium enhancement. The mass was posterior to the carotid bifurcation and anterolateral to the internal jugular vein. Radiographic findings were highly suspicious for a vagal paraganglioma or nerve sheath tumor. Urine catecholamines, vanillylmandelic acid (VMA) panel and thyroid function studies were all within normal limits. Succinyl dehydrogenase (SDH) gene testing was negative.Disclaimer: The opinions and assertions expressed herein are those of the authors and are not to be construed as official or representing the views of the Department of the Navy or the Department of Defense. I certify that all individuals who qualify as authors have been listed; each has participated in the conception and design of this work, the writing of the document, and the approval of the submission of this version; that the document represents valid work; that if we used information derived from another source, we obtained all necessary approvals to use it and made appropriate acknowledgements in the document; and that each takes public responsibility for it. We are military service members.

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Section: Discussionmentioning

confidence: 99%

Malignant Vagal Paraganglioma

Hamersley

Barrows

Perez

et al. 2015

Head and Neck Pathol

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“…Patients with bilateral CBTs are a somewhat special issue because bilateral lower cranial nerve palsies represent a severe life-threatening situation [ 14 ]. Velegrakis et al recommended always resecting the largest tumor first.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Follow-Up of a Patient with Bilateral Carotid Body Tumors after Unilateral Surgical Resection

Demir¹,

Uyar²,

Demir

et al. 2014

Am J Case Rep

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Patient: Female, 34Final Diagnosis: Carotid body tumorSymptoms: Dysphagia • hoarseness • non-tender neck swellingMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare diseaseBackground:Carotid body tumors are rare, highly vascularized neoplasms that arise from the paraganglia located at the carotid bifurcation. Surgery is the only curative treatment. However, treatment of bilateral carotid body tumors represents a special challenge due to potential neurovascular complications.Case Report:We present the therapeutic management of a 34-year-old woman with bilateral carotid body tumors. The patient underwent surgical resection of the largest tumor. It was not possible to resect the tumor without sacrificing the ipsilateral vagal nerve. Due to unilateral vagal palsy, we decide to withhold all invasive therapy and to observe contralateral tumor growth with serial imaging studies. The patient is free of disease progression 5 years later.Conclusions:Treatment of bilateral CBTs should focus on preservation of the quality of life rather than on cure of the disease. In patients with previous contralateral vagal palsies, the choice between surgery and watchful waiting is a balance between the natural potential morbidity and the predictable surgical morbidity. Therefore, to avoid bilateral cranial nerve deficits, these patients may be observed until tumor growth is determined, and, if needed, treated by radiation therapy.

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“…Nevertheless, radiotherapy is a well-known alternative for patients who cannot undergo surgery due to age, comorbid conditions, or to minimize the risk of baroreflex failure syndrome and avoid its long term treatment. 54,55…”

Section: Radiotherapymentioning

confidence: 99%

Current trends in carotid body tumors: Comprehensive review

et al. 2022

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Background: Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. Methods: Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. Results: Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. Conclusion:This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates.

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Synchronous malignant vagal paraganglioma with contralateral carotid body paraganglioma treated by radiation therapy

Cited by 10 publications

References 18 publications

Malignant Vagal Paraganglioma

Malignant Vagal Paraganglioma

Five-Year Follow-Up of a Patient with Bilateral Carotid Body Tumors after Unilateral Surgical Resection

Current trends in carotid body tumors: Comprehensive review

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