Carotid paragangliomas: case report and imaging review
, 2, 3, 4, 5, 6
Abstract
Background: Presentation of case reviews depicting the imaging characteristics of carotid paragangliomas, associated with a thorough analysis of the anatomical morphological features and the current therapeutic strategies.
Materials and methods: We present the cases of 3 patients diagnosed with carotid paragangliomas in our clinic, illustrating diagnostic imaging elements by computer tomography (CT) and magnetic resonance imaging (MRI), but also the postoperative aspect of the carotid system, with respective anatomical, clinical and surgical considerations.
Results: The imaging aspect of the carotid paragangliomas is characterised by a mass of soft tissue with intense contrast enhancement and with “salt and pepper” MRI appearance on conventional spin-echo sequences. The postoperative evolution of the patients included in the article was favourable, without any perioperative complications or signs of local tumour recurrence.
Conclusions: Carotid paragangliomas are rare, often asymptomatic tumours, but with potential for increased malignancy, which raises the need for good knowledge of the cervical region pathology as well as the features of neuroendocrine tumours. CT and MRI examinations are essential for diagnosis, staging and, implicitly, for establishing the therapeutic strategy.
Keywords: paragangliomacarotid body tumourcarotid arteriesdiagnostic toolsimagingtherapeutic strategy
References
- Albsoul NM, Alsmady MM, Al-Aardah MI, et al. Carotid body paraganglioma management and outcome. Eur J Sci Res. 2009; 37(4): 567–574.
- Arya S, Rao V, Juvekar S, et al. Carotid body tumors: objective criteria to predict the Shamblin group on MR imaging. Am J Neuroradiol. 2008; 29(7): 1349–1354.
- Boedeker CC, Neumann HPH, Maier W, et al. Malignant head and neck paragangliomas in SDHB mutation carriers. Otolaryngol Head Neck Surg. 2007; 137(1): 126–129.
- Carroll W, Stenson K, Stringer S. Malignant carotid body tumor. Head Neck. 2004; 26(3): 301–306.
- Dahia PLM. Pheochromocytoma and paraganglioma pathogenesis: learning from genetic heterogeneity. Nat Rev Cancer. 2014; 14(2): 108–119.
- Davidovic LB, Djukic VB, Vasic DM, et al. Diagnosis and treatment of carotid body paraganglioma: 21 years of experience at a clinical center of Serbia. World J Surg Oncol. 2005; 3(1): 10.
- Davila VJ, Chang JM, Stone WM, et al. Current surgical management of carotid body tumors. J Vasc Surg. 2016; 64(6): 1703–1710.
- Dixon JL, Atkins MD, Bohannon WT, et al. Surgical management of carotid body tumors: a 15-year single institution experience employing an interdisciplinary approach. Proc (Bayl Univ Med Cent). 2016; 29(1): 16–20.
- Farımaz M, Çelik HH, Ergun KM, et al. The morphometry of the cavernous part of the internal carotid artery. Folia Morphol. 2019; 78(1): 54–62.
- Fliedner SMJ, Lehnert H, Pacak K. Metastatic paraganglioma. Semin Oncol. 2010; 37(6): 627–637.
- Gilbo P, Morris CG, Amdur RJ, et al. Radiotherapy for benign head and neck paragangliomas: a 45-year experience. Cancer. 2014; 120(23): 3738–3743.
- Itawi SA, Buehler M, Mrak RE, et al. A unique case of carotid splaying by a cervical vagal neurofibroma and the role of neuroradiology in surgical management. Cureus. 2017; 9(9): e1658.
- Jackson RS, Myhill JA, Padhya TA, et al. The effects of preoperative embolization on carotid body paraganglioma surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015; 153(6): 943–950.
- Lee JH, Barich F, Karnell LH, et al. National Cancer Data Base report on malignant paragangliomas of the head and neck. Cancer. 2002; 94(3): 730–737.
- Lee KiY, Oh YW, Noh HJ, et al. Extraadrenal paragangliomas of the body: imaging features. Am J Roentgenol. 2006; 187(2): 492–504.
- Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, et al. Does Shamblin's classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin's classification. Eur Arch Otorhinolaryngol. 2006; 263(2): 171–175.
- Malec K, Cenda P, Brzewski P, et al. Paragangliomas of head and neck: A surgical challenge. J Craniomaxillofac Surg. 2017; 45(1): 127–130.
- Mannelli M, Castellano M, Schiavi F, et al. Clinically guided genetic screening in a large cohort of italian patients with pheochromocytomas and/or functional or nonfunctional paragangliomas. J Clin Endocrinol Metab. 2009; 94(5): 1541–1547.
- McCrary HC, Babajanian E, Calquin M, et al. Characterization of malignant head and neck paragangliomas at a single institution across multiple decades. JAMA Otolaryngol Head Neck Surg. 2019; 145(7): 641–646.
- Moore MG, Netterville JL, Mendenhall WM, et al. Head and neck paragangliomas: an update on evaluation and management. Otolaryngol Head Neck Surg. 2016; 154(4): 597–605.
- Muhm M, Polterauer P, Gstöttner W, et al. Diagnostic and therapeutic approaches to carotid body tumors. Review of 24 patients. Arch Surg. 1997; 132(3): 279–284.
- Obholzer RJ, Hornigold R, Connor S, et al. Classification and management of cervical paragangliomas. Ann R Coll Surg Engl. 2011; 93(8): 596–602.
- Offergeld C, Brase C, Yaremchuk S, et al. Head and neck paragangliomas: clinical and molecular genetic classification. Clinics. 2012; 67(S1): 19–28.
- Olsen WL, Dillon WP, Kelly WM, et al. MR imaging of paragangliomas. Am J Roentgenol. 1987; 148(1): 201–204.
- Pacheco-Ojeda LA. Carotid body tumors: Surgical experience in 215 cases. J Craniomaxillofac Surg. 2017; 45(9): 1472–1477.
- Rush BF. Jr. Current concepts in the treatment of carotid body tumors. Surgery. 1962; 52: 679–684.
- Shamblin WR, ReMine WH, Sheps SG, et al. Carotid body tumor (chemodectoma). Am J Surg. 1971; 122(6): 732–739.
- Sobol SM, Dailey JC. Familial multiple cervical paragangliomas: report of a kindred and review of the literature. Otolaryngol Head Neck Surg. 1990; 102(4): 382–390.
- Somasundar P, Krouse R, Hostetter R, et al. Paragangliomas?A decade of clinical experience. J Surg Oncol. 2000; 74(4): 286–290, doi: 10.1002/1096-9098(200008)74:4<286::aid-jso9>3.0.co;2-c.
- Sykes J, Ossoff R. Paragangliomas of the Head and Neck. Otolaryngol Clin North Am. 1986; 19(4): 755–767.
- Thelen J, Bhatt AA. Multimodality imaging of paragangliomas of the head and neck. Insights Imaging. 2019; 10(1): 29.
- van den Berg R. Imaging and management of head and neck paragangliomas. Eur Radiol. 2005; 15(7): 1310–1318.
- West CT, Brassett C, Gaunt ME. Variations in carotid sinus anatomy and their relevance to carotid interventions. Folia Morphol. 2018; 77(4): 693–697.
- Williams MD. Paragangliomas of the head and neck: an overview from diagnosis to genetics. Head Neck Pathol. 2017; 11(3): 278–287.
- Woolen S, Gemmete JJ. Paragangliomas of the Head and Neck. Neuroimaging Clin N Am. 2016; 26(2): 259–278.
- Zeitler DM, Glick J, Har-El G. Preoperative embolization in carotid body tumor surgery: is it required? Ann Otol Rhinol Laryngol. 2010; 119(5): 279–283.
