Carotid Body Tumors

2017 ◽  
Author(s):  
Audra A Duncan
Keyword(s):  
Succinate Dehydrogenase ◽  
Nerve Injury ◽  
Carotid Body ◽  
Stroke Risk ◽  
Nasotracheal Intubation ◽  
Cranial Nerves ◽  
Autonomic Nerve ◽  
Type I ◽  
Tumor Embolization ◽  
Carotid Body Tumors

Carotid body tumors (CBTs) are derived from parasympathetic autonomic nervous system cells and are the most common type of head and neck paragangliomas, accounting for 65-80% of lesions.  CBTs may occur sporadically, may be familial with identified gene mutations on the succinate dehydrogenase subunit, or a component of familial neuroendocrine syndromes.  Environments or medical conditions leading to chronic hypoxia can increase the risk of CBTs.  The differential diagnosis of CBT include other neck masses such as enlarged lymph nodes or other neck tumors.  Computed tomography or magnetic resonance angiography is often diagnostic as CBTs cause a characteristic splaying of the carotid bifurcation.  The degree of encasement of the carotid arteries is classified by Shamblin Type I-III, and the higher Shamblin category correlates to highest risk of nerve injury after surgical resection.  All tumors should be removed in healthy patients, with observation or radiotherapy reserved for high-risk or elderly asymptomatic patients.  Tumor embolization may be considered in CBTs larger than 4cm.  Resection, with or without tumor embolization, requires adequate exposure of the distal carotid with consideration of nasotracheal intubation or mandibular subluxation.  The surgeon must be prepared to resect and replace the carotid artery in large CBTs using techniques similar to carotid endarterectomy to reduce stroke risk.   Cranial nerves should be carefully exposed and preserved during a systematic dissection.  Despite careful resection, cranial nerve injury may be as high as 30-40%, although only 5% are permanent.  Stroke risk (1%) and mortality (<1%) are low. KEY WORDS: Carotid body tumor, succinate dehydrogenase, Shamblin Type, neuroendocrine tumors, parasympathetic autonomic nerve cells, tumor embolization

Carotid Body Tumors in Humans Caused by a Mutation in the Gene for Succinate Dehydrogenase D (SDHD)

2004 ◽  
pp. 71-76 ◽  
Author(s):  
Albert Dahan ◽  
Peter E. M. Taschner ◽  
Jeroen C. Jansen ◽  
Andel van der Mey ◽  
Luc J. Teppema ◽  
...  
Keyword(s):  
Succinate Dehydrogenase ◽  
Carotid Body ◽  
Carotid Body Tumors

scholarly journals Temporary balloon occlusion and ethanol injection for preoperative embolization of carotid-body tumor

2002 ◽  
Vol 81 (8) ◽  
pp. 536-547 ◽  
Author(s):  
Michael Horowitz ◽  
Richard E. Whisnant ◽  
Charles Jungreis ◽  
Carl Snyderman ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Carotid Body ◽  
Balloon Occlusion ◽  
Carotid Body Tumor ◽  
Preoperative Embolization ◽  
Ethanol Injection ◽  
Tumor Embolization ◽  
Histologic Evaluation ◽  
Carotid Body Tumors ◽  
Ethanol Embolization ◽  
Temporary Balloon Occlusion

We report on the preoperative embolization of a carotid-body paraganglioma by temporary balloon occlusion and ethanol injection. Complete devascularization was achieved without complication. Resection after a short postembolization interval required artery sacrifice. Histologic evaluation revealed that the tumor contained diffuse ethanol-induced microemboli. Compared with unembolized and polyvinyl-alcohol-embolized carotid-body paragangliomas, our technique resulted in no greater adverse effects on the tumor-vessel interface. This procedure is an effective and promising method of preoperative embolization of carotid-body tumors and warrants further experience and study. In this article, we also review the literature on carotid-body tumor embolization and ethanol embolization.

Carotid body tumors: a subject review and suggested surgical approach

1986 ◽  
Vol 64 (3) ◽  
pp. 377-385 ◽  
Author(s):  
Fredric B. Meyer ◽  
Thoralf M. Sundt ◽  
Bruce W. Pearson
Keyword(s):  
Carotid Body ◽  
Surgical Approach ◽  
Intraoperative Monitoring ◽  
Cranial Nerves ◽  
Surgical Results ◽  
Major Morbidity ◽  
Content Type ◽  
Carotid Body Tumors ◽  
Lower Cranial Nerves ◽  
Fine Print

✓ Carotid body tumors are a rare but potentially difficult surgical entity. Their pathology, physiology, and natural history are reviewed along with surgical results reported in the literature. A surgical approach for removal of these tumors is presented which differs significantly from the recommended techniques in that emphasis is placed on intraoperative monitoring of cerebral blood flow, the selective use of shunts, a tumor-adventitial plane of dissection, preservation of the carotid artery complex, and mobilization of the parotid gland. Thirteen cases using these techniques are reviewed. The mortality rate and the incidence of cerebrovascular sequelae were both 0%. The major morbidity consisted of injury to the lower cranial nerves in five patients (39%) with tumors larger than 5 cm in length.

Results of combined preoperative direct percutaneous embolization and surgical excision in treatment of carotid body tumors

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 461-466 ◽  
Author(s):  
Sahin ◽  
Jahollari ◽  
Guler ◽  
Doganci ◽  
Bingol ◽  
...  
Keyword(s):  
Carotid Body ◽  
Duplex Ultrasound ◽  
Surgical Excision ◽  
Daily Practice ◽  
Vascular Reconstruction ◽  
Carotid Body Tumor ◽  
Diagnostic Tools ◽  
Type I ◽  
Percutaneous Embolization ◽  
Carotid Body Tumors

Background: Carotid body tumors are infrequent neoplasms in daily practice. Diagnostic difficulties exist because of their slow growth and asymptomatic progress. The surgical treatment is complicated and difficult due to their proximity to vascular and neural structures. In this study we present the results of 12 patients operated for carotid body tumor that underwent preoperative percutaneous direct embolization. Patients and methods: The data of 12 patients, diagnosed with carotid body tumor and surgically treated at our department between 2000 and 2010, was retrospectively analyzed. Duplex ultrasound, computerized tomography and selective carotid angiography were the applied diagnostic tools. Two days before the planned surgery all patients underwent percutaneous direct embolization to achieve devascularization of the tumor. Afterwards, surgical excision of the mass under general anesthesia was performed in all cases. Results: Five tumors were classified as Shamblin type I (41.7%), and the others were type II (58.3%). All masses were removed sub-adventitially and no vascular reconstruction was necessary. There was no mortality and no permanent neural damage. Malfunction of the tongue was observed in only one case, which recovered completely in one month. There was one recurrence detected by Duplex ultrasound and angiography during the follow up period. Conclusions: Surgical excision is mandatory to be performed as soon as diagnosed in carotid body tumors. Preoperative direct percutaneous embolization of the mass helps to devascurize the tumor, enabling an optimal surgical procedure. The outcomes of such a combined intervention are excellent and neurovascular structure preservation decreases complication and morbidity rates.

Presentation with Personality changes and Tinnitus to a Vascular Intervention: Rare case of Carotid Body Paraganglioma

2018 ◽  
pp. e000109
Author(s):  
Ahsan Zil-E-Ali ◽  
Zubair Ahmed ◽  
Amber Ehsan Faquih ◽  
Muhammad Ishaq ◽  
Muhammad Aadil
Keyword(s):  
Case Report ◽  
Carotid Body ◽  
Neuroendocrine Neoplasms ◽  
Vascular Surgeon ◽  
Vascular Intervention ◽  
Presenting Symptoms ◽  
Personality Changes ◽  
Tender Mass ◽  
Carotid Body Tumors ◽  
General Physical

Background: Carotid body paragangliomas are rare neuroendocrine neoplasms of chromaffin negative glomus cells. This case report explains an atypical case with unusual presentation and treatment. Case Report: A healthy smoker technician by profession was brought to the emergency room (ER) with coprolalia. The general physical exam did not reveal any information. His history revealed unilateral tinnitus and odynophagia leading to a consultation by the neurologist with head imaging. Acoustic neuroma was ruled out and the caregiver was asked to elaborate the events mentioned in the history and a psychiatric examination was done. The personality changes were evaluated by the psychiatrist that showed overlapping of delirium and depression. The patient was further examined by a vascular surgeon. After careful revisiting of the history, examination and indication of tender mass in the neck by the patient's vascular surgeon, the diagnosis of carotid body paraganglioma was made which was followed by surgical resection for treatment. Conclusion: Carotid Body Paragangliomas are very vascular structures and their manipulation in a surgery setting requires expertise. This case presented with personality changes and tinnitus, a very less likely event to occur in a carotid body tumor. The present care report, thus adds on to the literature of carotid body tumors and its presenting symptoms.

scholarly journals A Family With a Carotid Body Paraganglioma and Thyroid Neoplasias With a New SDHAF2 Germline Variant

2019 ◽  
Vol 3 (11) ◽  
pp. 2151-2157
Author(s):  
Katherine I Wolf ◽  
Michelle F Jacobs ◽  
Rohit Mehra ◽  
Priya Begani ◽  
Matthew S Davenport ◽  
...  
Keyword(s):  
Succinate Dehydrogenase ◽  
Carotid Body ◽  
Follicular Adenoma ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Whole Body ◽  
Whole Body Mri ◽  
Pathogenic Variants ◽  
Assembly Factor ◽  
Associated Tumors

Abstract At least 30% of all pheochromocytomas (PCCs)/paragangliomas (PGLs) arise in patients with a germline predisposition syndrome. Variants in succinate dehydrogenase subunits A, B, C, and D (SDHA, SDHB, SDHC, and SDHD) are the most common pathogenic germline alterations. Few pathogenic variants have been reported in succinate dehydrogenase assembly factor 2 (SDHAF2). Here, we describe a 30-year-old female patient who presented with a left-sided neck mass, which was later characterized as a carotid body PGL. Genetic testing revealed a likely pathogenic SDHAF2 variant (c.347G>A;p.W116X). Two sisters carried the same pathologic variant, and screening protocols were recommended. Whole-body MRI revealed thyroid nodules; this testing was followed by fine-needle aspiration, which confirmed papillary thyroid carcinoma in one sister and a follicular adenoma in the other. The two sisters then underwent hemithyroidectomy and total thyroidectomy, respectively. Because evidence for pathogenic variants in SDHAF2 causing predisposition to PCC/PGL is limited, we discuss the challenges in mutational variant interpretation and decision making regarding screening for associated tumors.

Characteristics of carotid body chemosensitivity in NADPH oxidase-deficient mice

2002 ◽  
Vol 282 (1) ◽  
pp. C27-C33 ◽  
Author(s):  
L. He ◽  
J. Chen ◽  
B. Dinger ◽  
K. Sanders ◽  
K. Sundar ◽  
...  
Keyword(s):  
Tyrosine Hydroxylase ◽  
Nadph Oxidase ◽  
Carotid Body ◽  
Gene Knockout ◽  
Type I ◽  
Type I Cells ◽  
Carotid Bodies ◽  
Marker Antigen ◽  
I Cells

Various heme-containing proteins have been proposed as primary molecular O2 sensors for hypoxia-sensitive type I cells in the mammalian carotid body. One set of data in particular supports the involvement of a cytochrome b NADPH oxidase that is commonly found in neutrophils. Subunits of this enzyme have been immunocytochemically localized in type I cells, and diphenyleneiodonium, an inhibitor of the oxidase, increases carotid body chemoreceptor activity. The present study evaluated immunocytochemical and functional properties of carotid bodies from normal mice and from mice with a disrupted gp91 phagocytic oxidase (gp91 phox ) DNA sequence gene knockout (KO), a gene that codes for a subunit of the neutrophilic form of NADPH oxidase. Immunostaining for tyrosine hydroxylase, a signature marker antigen for type I cells, was found in groups or lobules of cells displaying morphological features typical of the O2-sensitive cells in other species, and the incidence of tyrosine hydroxylase-immunopositive cells was similar in carotid bodies from both strains of mice. Studies of whole cell K+currents also revealed identical current-voltage relationships and current depression by hypoxia in type I cells dissociated from normal vs. KO animals. Likewise, hypoxia-evoked increases in intracellular Ca2+ concentration were not significantly different for normal and KO type I cells. The whole organ response to hypoxia was evaluated in recordings of carotid sinus nerve activity in vitro. In these experiments, responses elicited by hypoxia and by the classic chemoreceptor stimulant nicotine were also indistinguishable in normal vs. KO preparations. Our data demonstrate that carotid body function remains intact after sequence disruption of the gp91 phox gene. These findings are not in accord with the hypothesis that the phagocytic form of NADPH oxidase acts as a primary O2 sensor in arterial chemoreception.

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